Management of Hydrocephalus Secondary to Intraventricular Hemorrhage in the Preterm Infant with a Subcutaneous Ventricular Catheter Reservoir

McComb, J. Gordon; Ramos, Alexander; Platzker, Arnold C. G.; Henderson, Diane; Segall, H D

doi:10.1227/00006123-198309000-00014

Cited by 84 publications

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“…5,9 External ventricular drainage carries an exceptionally high risk of infection, and is not routinely recommended. 10 Ventriculosubgaleal shunt placement allows continuous drainage of CSF to a subgaleal pouch.…”

Section: Discussionmentioning

confidence: 99%

“…4 A ventricular reservoir, such as the Rickham or McComb reservoir, can be tapped repeatedly for weeks to decompress the ventricular system while awaiting optimal conditions for permanent CSF drainage through a ventriculo-peritoneal (V-P) shunt. Although the ventricular reservoir is effective for the management of rapidly progressing PHVD in preterm infants, [5][6][7] limited data are available regarding the risk of serial invasive tapping of a ventricular reservoir over a prolonged period. One of the major concerns has been the occurrence of reservoir infection from repeated tapping.…”

Section: Introductionmentioning

confidence: 99%

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Repeated tapping of ventricular reservoir in preterm infants with post-hemorrhagic ventricular dilatation does not increase the risk of reservoir infection

et al. 2009

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Objective: Controlled removal of cerebrospinal fluid (CSF) by serial tapping of ventricular reservoir, such as the McComb reservoir, is an effective way to decompress the ventricular system in preterm infants with rapidly progressing post-hemorrhagic ventricular dilatation (PHVD) while awaiting optimal conditions for permanent CSF drainage through a ventriculo-peritoneal shunt. However, the data regarding the risk of infection from repeated invasive tapping of a ventricular reservoir over a prolonged period are scarce. The aim of this study is to determine the incidence of ventricular reservoir infection from repeated tapping and to evaluate how often reservoir infection accompanies blood culture-proven sepsis in preterm infants with PHVD.Study Design: We reviewed the medical records of all infants with PHVD receiving serial reservoir tap at the University of Michigan from January 2000 through June 2007. Serial reservoir taps were carried out by the neonatology team using aseptic technique. Surveillance CSF cultures were sent on a weekly basis as per unit practice or when clinical sepsis was suspected. Reservoir-tapping-related infection was present if a reservoir became infected during serial tapping 7 days or more after surgical placement of the reservoir.Result: During the study period, ventricular reservoirs were placed in 35 infants for management of hydrocephalus. Six infants (17%) received ventricular reservoirs secondary to post-meningitic hydrocephalus or congenital brain malformations and were excluded. In the remaining 29 infants (birth weight: 1070 ± 639 g (range 525 to 3204); gestational age: 26.9±4.1 weeks (range 23 to 40)) with PHVD, serial tapping of the ventricular reservoir was performed on 681 occasions (average number of taps per infant: 24 (range 2 to 82)). There were no cases of CSF culture-proven reservoir infection related to repeated taps. Thirteen of the 29 (45%) infants with PHVD developed blood culture-proven late onset sepsis with the following organisms: coagulase-negative Staphylococcus (9), Candida albicans (2), Escherichia coli (1), and Staphylococcus aureus (1), but all of the accompanying CSF cultures from the reservoir were negative.Conclusion: Ventricular reservoir infection from serial taps neither occurred in this consecutive series of preterm infants with PHVD, nor did ventricular reservoir infection accompany blood culture-proven sepsis. Concern of reservoir infection from repeated tapping should not be a limiting factor against placement of reservoirs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Repeated tapping of ventricular reservoir in preterm infants with post-hemorrhagic ventricular dilatation does not increase the risk of reservoir infection

et al. 2009

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“…9,10,16,18,28 The severe neurological complications associated with IVH and PHH and the increasing survival rates of infants with extremely low birth weights necessitate a better understanding of the benefits and disadvantages associated with the reservoir and VSGS. In this study, a retrospective review of preterm infants treated for IVH and PHH at a single institution over a 14-year period was performed.…”

mentioning

confidence: 99%

Ventricular reservoir versus ventriculosubgaleal shunt for posthemorrhagic hydrocephalus in preterm infants: infection risks and ventriculoperitoneal shunt rate

Wang

Amin

Jallo

et al. 2014

PED

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Object The most common neurosurgical condition observed in preterm infants is intraventricular hemorrhage (IVH), which often results in posthemorrhagic hydrocephalus (PHH). These conditions portend an unfavorable prognosis; therefore, the potential for poor neurodevelopmental outcomes necessitates a better understanding of the comparative effectiveness of 2 temporary devices commonly used before the permanent insertion of a ventriculoperitoneal (VP) shunt: the ventricular reservoir and the ventriculosubgaleal shunt (VSGS). Methods The authors analyzed retrospectively collected information for 90 patients with IVH and PHH who were treated with insertion of a ventricular reservoir (n = 44) or VSGS (n = 46) at their institution over a 14-year period. Results The mean gestational age and weight at device insertion were lower for VSGS patients (30.1 ± 1.9 weeks, 1.12 ± 0.31 kg) than for reservoir patients (31.8 ± 2.9 weeks, 1.33 ± 0.37 kg; p = 0.002 and p = 0.004, respectively). Ventricular reservoir insertion was predictive of more CSF taps prior to VP shunt placement compared with VSGS placement (10 ± 8.7 taps vs 1.6 ± 1.7 taps, p < 0.001). VSGS patients experienced a longer time interval prior to VP shunt placement than reservoir patients (80.8 ± 67.5 days vs 48.8 ± 26.4 days, p = 0.012), which corresponded to VSGS patients gaining more weight by the time of shunt placement than reservoir patients (3.31 ± 2.0 kg vs 2.42 ± 0.63 kg, p = 0.016). Reservoir patients demonstrated a trend toward more positive CSF cultures compared with VSGS patients (n = 9 [20.5%] vs n = 5 [10.9%], p = 0.21). There were no significant differences in the rates of overt device infection requiring removal (reservoir, 6.8%; VSGS, 6.5%), VP shunt insertion (reservoir, 77.3%; VSGS, 76.1%), or early VP shunt infection (reservoir, 11.4%; VSGS, 13.0%) between the 2 cohorts. Conclusions Although the rates of VP shunt requirement and device infection were similar between patients treated with the reservoir versus the VSGS, VSGS patients were significantly older and had achieved greater weights at the time of VP shunt insertion. The authors' results suggest that the VSGS requires less labor-intensive management by ventricular tapping; the VSGS patients also attained higher weights and more optimal surgical candidacy at the time of VP shunt insertion. The potential differences in long-term developmental and neurological outcomes between VSGS and reservoir placement warrant further study.

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“…If this occurs, sometimes serial ventricular punctures are used; however, this can lead to additional parenchymal damage and possible porencephaly at the aspiration site. 6,9 For this reason, it is believed better to insert a ventricular access device that only traverses the cortical mantle on a single occasion. A consideration in using a temporary means of CSF drainage is that a given number of these preterm infants develop necrotizing enterocolitis (NEC) that leads to bowel perforation.…”

mentioning

confidence: 99%

“…The insertion of a ventricular reservoir (VR) to intermittently remove CSF was described as a treatment for preterm infants with PHH at our institution in 1983 6 and is often the temporizing measure of choice for treatment of PHH. 8 More recently, the placement of a ventriculosubgaleal (VSG) shunt as another temporizing neurosurgical procedure to control progressive hydrocephalus after IVH has been developed as an alternate to a VR.…”

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confidence: 99%

Surgical management of hydrocephalus secondary to intraventricular hemorrhage in the preterm infant

Christian

Melamed

et al. 2016

PED

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OBJECT Posthemorrhagic hydrocephalus (PHH) in the preterm infant remains a major neurological complication of prematurity. The authors first described insertion of a specially designed low-profile subcutaneous ventricular catheter reservoir for temporary management of hydrocephalus in 1983. This report presents the follow-up experience with the surgical management of PHH in this population and describes outcomes both in infants who were stable for permanent shunt insertion and those initially temporized with a ventricular reservoir (VR) prior to permanent ventriculoperitoneal (VP)/ventriculoatrial (VA) shunt placement. METHODS A retrospective review was undertaken of the medical records of all premature infants surgically treated for posthemorrhagic hydrocephalus (PHH) between 1997 and 2012 at Children’s Hospital Los Angeles. RESULTS Over 14 years, 91 preterm infants with PHH were identified. Fifty neonates received temporizing measures via a VR that was serially tapped for varying time periods. For the remaining 41 premature infants, VP/VA shunt placement was the first procedure. Patients with a temporizing measure as their initial procedure had undergone CSF diversion significantly earlier in life than those who had permanent shunting as the initial procedure (29 vs 56 days after birth, p < 0.01). Of the infants with a VR as their initial procedure, 5/50 (10%) did not undergo subsequent VP/VA shunt placement. The number of shunt revisions and the rates of loculated hydrocephalus and shunt infection did not statistically differ between the 2 groups. CONCLUSIONS Patients with initial VR insertion as a temporizing measure received a CSF diversion procedure significantly earlier than those who received a permanent shunt as their initial procedure. Otherwise, the outcomes with regard to shunt revisions, loculated hydrocephalus, and shunt infection were not different for the 2 groups.

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Management of Hydrocephalus Secondary to Intraventricular Hemorrhage in the Preterm Infant with a Subcutaneous Ventricular Catheter Reservoir

Cited by 84 publications

References 0 publications

Repeated tapping of ventricular reservoir in preterm infants with post-hemorrhagic ventricular dilatation does not increase the risk of reservoir infection

Repeated tapping of ventricular reservoir in preterm infants with post-hemorrhagic ventricular dilatation does not increase the risk of reservoir infection

Ventricular reservoir versus ventriculosubgaleal shunt for posthemorrhagic hydrocephalus in preterm infants: infection risks and ventriculoperitoneal shunt rate

Surgical management of hydrocephalus secondary to intraventricular hemorrhage in the preterm infant

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