Implantation of Ommaya reservoir in extremely low weight premature infants with posthemorrhagic hydrocephalus: a cautious option

Abstract

The implantation of Ommaya reservoir is a cautious option of treating low-weight premature infants with PHH because of a relatively high complication rate. However, VP shunt surgery may be avoided in some infants.

Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study

“…However, published rates of conversion from a temporary device to a permanent shunt in this population range from just over 50% to as high as 85%. 3,[6][7][8][9]11,13,16,22,25,27 Traditional temporization approaches include diuretic administration and serial lumbar puncture and have been shown to be largely ineffective in preventing the need for permanent shunting. 31,32 The patient is therefore typically treated with 1 of 2 available surgical temporization procedures: subcutaneously implanted VRs or VSGSs.…”

“…Also, the transcutaneous CSF withdrawal, with incremental removal of blood product and protein from within the ventricles, has been hypothesized to diminish the chance of long-term communicating hydrocephalus. 3,6,7,9,11,16 VR avoids the main complications of other means of intermittent CSF withdrawal, such as repeated lumbar puncture (which frequently yields only a small volume of CSF) and repeated transcortical ventricle puncture (with its risk of intracranial hemorrhage or cystic encephalomalacia). 6 Proponents of VR also believe that it can reduce the need for permanent ventriculoperitoneal (VP) shunting in some patients by allowing the CSF to build up between taps (thereby challenging the infant's natural CSF absorption system).…”

“…Complications of the reservoir include CSF leak, infection, or possible skin breakdown, with an incidence up to 22%. 5,11,20,23 Some reports suggest that permanent VP shunting can be avoided in 10%-30% of cases after VR, but the actual incidence is likely related to multiple factors, especially treatment selection criteria (i.e., when to treat, when to convert). 7,20,23,33 VSGSs have the benefit of a closed system of CSF diversion without the perceived risks associated with intermittent transcutaneous tapping.…”

“…Several single-center series report the incidence of shunt placement in these children using either subcutaneous reservoirs for intermittent percutaneous removal of CSF or ventriculosubgaleal shunt (VSGS) placement. 3,[6][7][8][9]11,16,17,19,22,23,[25][26][27] Two recent notable publications report the retrospectively reviewed single-center experience using both. 14,28 In 2009, the Hydrocephalus Clinical Research Network (HCRN) published an initial paper in which the permanent shunt rates were evaluated in a 147-patient retrospective nonstandardized cohort.…”

Introduction of percutaneous-tunneled transfontanellar external ventricular drainage in the management of hydrocephalus in extremely low-birth-weight infants

“…16 Extremely low-birth-weight infants represent a subgroup of hydrocephalic patients in whom early surgical treatment of the hydrocephalus represents a challenge for many reasons: thinness of skin, risk of skin ulceration, CSF fistula, infection, and pulmonary hemodynamic instability together with the inability to move the infant out of the incubator. Concern about these frequent complications 12 of standard treatments can delay surgery, and the infant's weight increase in this period of delay will reduce the operative risk. Indeed, from a surgical point of view, operating on an infant weighing 950 g is incomparably easier and safer than performing the same operation on the same patient when he or she weighs 500 g (both cases are considered ELBW) since the lower the weight, the fewer the feasible surgical options and the higher the risks.…”