Congenital hydrocephalus in the northeast of Brazil: epidemiological aspects, prenatal diagnosis, and treatment

Melo, José Roberto Tude; Melo, Emília Nunes de; Vasconcellos, Ângela G.; Pacheco, Pollyana

doi:10.1007/s00381-013-2111-y

Cited by 13 publications

(24 citation statements)

References 21 publications

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“…Our data corroborate these earlier findings; the patients treated with a VP shunt for initial PHH management had higher complication rates than those treated with a VP shunt as a second option during the follow-up period. In a series of children with congenital hydrocephalus described previously by our team 24 , we observed a much lower incidence of VP shunt-related complications than those observed in the current series, which confirms the need for extreme care in the selection of PHH patients for a VP shunt as a first CSF drainage option.…”

Section: Discussionsupporting

confidence: 87%

Cerebrospinal fluid drainage options for posthemorrhagic hydrocephalus in premature neonates

Melo¹,

Passos²,

Carvalho³

2017

Arq. Neuro-Psiquiatr.

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Objective: The literature describes various cerebrospinal fluid (CSF) drainage techniques to alleviate posthemorrhagic hydrocephalus in preterm newborns; however, consensus has not been reached. The scope of this study was describing a case series of premature neonates with posthemorrhagic hydrocephalus and assessing the outcomes of different approaches used for CSF diversion. Methods: A consecutive review of the medical records of neonates with posthemorrhagic hydrocephalus treated with CSF drainage was conducted. Results: Forty premature neonates were included. Serial lumbar puncture, ventriculosubgaleal shunt, and ventriculoperitoneal shunt were the treatments of choice in 25%, 37.5% and 37.5% of the cases, respectively. Conclusion: Cerebrospinal fluid diversion should be tailored to each case with preference given to temporary CSF drainage in neonates with lower age and lower birth-weight, while the permanent ventriculoperitoneal shunt should be considered in healthier, higher birth-weight neonates born closer to term.Keywords: cerebral hemorrhage; hydrocephalus; cerebrospinal fluid. RESUMOObjetivo: A literatura descreve várias opções de drenagem liquórica (DL) para alivio da hidrocefalia pós-hemorrágica (HPH) em neonatos prematuros; contudo, não existe um consenso sobre a melhor abordagem. O escopo deste estudo foi descrever uma série de casos de neonatos prematuros, portadores de HPH, verificando os resultados de diferentes técnicas utilizadas para DL. Métodos: Revisão consecutiva dos prontuários de neonatos com diagnostico de HPH submetidos a DL. Resultados: Quarenta recém-nascidos prematuros foram incluídos. A punção lombar seriada (PL), a derivação ventriculosubgaleal (VSG) e a derivação ventrículo peritoneal (VP) foram o tratamento escolhido em 25%, 37,5% e 37,5% dos casos, respectivamente. Conclusão: As opções de DL devem ser avaliadas caso a caso, sendo dada preferência às drenagens temporária em prematuros com idade e peso mais baixos ao nascer, enquanto o shunt definitivo (derivação VP) pode ser considerado naqueles prematuros mais saudáveis, com idade e peso superiores.Palavras-chave: hemorragia cerebral; hidrocefalia; líquido cefalorraquidiano. Intraventricular hemorrhage (IVH) has been a major cause of mortality among premature neonates for more than 40 years 1,2 and is associated with neonatal encephalopathy, subsequent subtle apnea, and death 1,2,3,4 . Low birth-weight premature neonates are more vulnerable to IVH and, depending on the IVH grade, to posthemorrhagic hydrocephalus (PHH). Posthemorrhagic hydrocephalus can evolve to progressive PHH, and in more severe cases, to periventricular hemorrhagic infarct, hemorrhagic cerebral injury, and periventricular leukomalacia 1,4,5 . Between 15% to 20% of neonates born with a weight less than 1,500 g are estimated to develop IVH. Further, 75% of those with Papile grade III or IV hemorrhages develop progressive PHH and need a permanent shunt 4,6 .The literature does not clearly indicate any standardized protocols for the best PHH treatment o...

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Section: Discussionsupporting

confidence: 87%

Cerebrospinal fluid drainage options for posthemorrhagic hydrocephalus in premature neonates

Melo¹,

Passos²,

Carvalho³

2017

Arq. Neuro-Psiquiatr.

Self Cite

View full text Add to dashboard Cite

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“…A previous study identified the irregularity and deficiency of prenatal monitoring in pregnant women, assisted by a poor public health system, in the state of Bahia (Brazil) 17 and indicated that these may be associated with the high incidence of spinal dysraphism 5,22,23 . We recommend, as suggested by other authors, that at least 400 µg of a folic acid supplement should be consumed daily; patients with an intermediate to high risk of neural tube defects (such as patients with a previous well-known history of neural tube defects) should consume 4-5 mg folic acid 5,22,23 .…”

Section: Discussionmentioning

confidence: 99%

“…We consider the measure of HC and evaluation of the fontanels as the most important clinical signs to be observed in these children, according to previously published studies 11,15,16,17,19 . Infant girls with HC of 37.7 cm and infant boys with HC of 38.5 cm who showed an increase in the ventricular system were considered as having hydrocephalus since birth 17,18,20 . In this group, the proposal for treatment was of closure of MM and VP shunt at the same surgical time.…”

Section: Methodsmentioning

confidence: 99%

“…All the children included in this study underwent the same protocol for hydrocephalus in case of MM, as those described in previous reports 9,11,12 . Transcranial ultrasonography (TUS) was chosen as the radiological method for diagnosing hydrocephalus in all neonates, as that described in previous studies 15,16,17 , because of the difficulty in performing CT scan or MRI in these children. TUS was performed with a 1.9-to 6 MHz curvilinear transducer (Toshiba Aplio 100® with color Doppler), with a classical trans-fontanelar window approach by a trained operator (senior radiologist with > 10 years experience in TUS).…”

Section: Methodsmentioning

confidence: 99%

“…In this group, the proposal for treatment was of closure of MM and VP shunt at the same surgical time. VP shunt was chosen as the method of choice for treating hydrocephalus in these children after considering the benefits and drawbacks of endoscopic third ventriculostomy (ETV) in neonates with MM 12,17,21 .…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Clinical and ultrasonographic criteria for using ventriculoperitoneal shunts in newborns with myelomeningocele

Melo¹,

Pacheco²,

Melo³

et al. 2015

Arq. Neuro-Psiquiatr.

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Objective Hydrocephalus is one of the main complications associated with myelomeningocele (MM). This study aimed to identify clinical and ultrasonographic criteria for using ventriculoperitoneal (VP) shunts in this group of patients.Method A retrospective cohort study, based on established protocol for VP shunt implant in hydrocephalic children with MM. Parameters used to guide the indication of VP shunts included measurement of head circumference (HC), evaluation of fontanels, and measurement of lateral ventricular atrium (LVA) width by transcranial ultrasonography.Results 43 children were included in the analysis, of which 74% had hydrocephalus and required a VP shunt. These children had LVA width ≥ 15 mm, showed increased HC, or had bulging fontanels.Conclusion VP shunt is required in children with increased HC (≥ 2 standard deviation regarding age group), bulging fontanels, or LVA width of ≥ 15 mm after the closure of MM.

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Hydrocephalus

Adle‐Biassette

2018

Developmental Neuropathology

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Congenital hydrocephalus in the northeast of Brazil: epidemiological aspects, prenatal diagnosis, and treatment

Abstract: Public health measures are the key to increase mothers' knowledge about the importance of regular prenatal monitoring. There was a predominance of male children, with a median age of 3 months, with the majority coming from the countryside.

Cited by 13 publications

References 21 publications

Cerebrospinal fluid drainage options for posthemorrhagic hydrocephalus in premature neonates

Cerebrospinal fluid drainage options for posthemorrhagic hydrocephalus in premature neonates

Clinical and ultrasonographic criteria for using ventriculoperitoneal shunts in newborns with myelomeningocele

Hydrocephalus

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