Timing of Temporizing Neurosurgical Treatment in Relation to Shunting and Neurodevelopmental Outcomes in Posthemorrhagic Ventricular Dilatation of Prematurity: A Meta-analysis

Lai, Gilda; Chu-Kwan, William; Westcott, Annie B.; Kulkarni, Abhaya V.; Drake, James M.; Lam, Sandi

doi:10.1016/j.jpeds.2021.01.030

Cited by 16 publications

(11 citation statements)

References 79 publications

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“…Similarly, a retrospective review by Leijser et al comparing outcome in the early vs. late groups (26) showed that neurodevelopmental outcome at 2 years was significantly improved in the early intervention group i.e., intervention based on an increase in ventricular size rather than the onset of symptoms. This position was further supported in a metaanalysis comparing how the timing of temporizing intervention impacted on outcome (63). However, this enthusiasm has to be tempered by the potential risk posed by surgical intervention in this extremely vulnerable patient population.…”

Section: Early Intervention Before the Onset Of Symptoms May Improve ...mentioning

confidence: 96%

Secondary Brain Injury Following Neonatal Intraventricular Hemorrhage: The Role of the Ciliated Ependyma

Dawes

2022

Front. Pediatr.

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Intraventricular hemorrhage is recognized as a leading cause of hydrocephalus in the developed world and a key determinant of neurodevelopmental outcome following premature birth. Even in the absence of haemorrhagic infarction or posthaemorrhagic hydrocephalus, there is increasing evidence of neuropsychiatric and neurodevelopmental sequelae. The pathophysiology underlying this injury is thought to be due to a primary destructive and secondary developmental insult, but the exact mechanisms remain elusive and this has resulted in a paucity of therapeutic interventions. The presence of blood within the cerebrospinal fluid results in the loss of the delicate neurohumoral gradient within the developing brain, adversely impacting on the tightly regulated temporal and spatial control of cell proliferation and migration of the neural stem progenitor cells within the subventricular zone. In addition, haemolysis of the erythrocytes, associated with the release of clotting factors and leucocytes into the cerebrospinal (CSF), results in a toxic and inflammatory CSF microenvironment which is harmful to the periventricular tissues, resulting in damage and denudation of the multiciliated ependymal cells which line the choroid plexus and ventricular system. The ependyma plays a critical role in the developing brain and beyond, acting as both a protector and gatekeeper to the underlying parenchyma, controlling influx and efflux across the CSF to brain interstitial fluid interface. In this review I explore the hypothesis that damage and denudation of the ependymal layer at this critical juncture in the developing brain, seen following IVH, may adversely impact on the brain microenvironment, exposing the underlying periventricular tissues to toxic and inflammatory CSF, further exacerbating disordered activity within the subventricular zone (SVZ). By understanding the impact that intraventricular hemorrhage has on the microenvironment within the CSF, and the consequences that this has on the multiciliated ependymal cells which line the neuraxis, we can begin to develop and test novel therapeutic interventions to mitigate damage and reduce the associated morbidity.

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Section: Early Intervention Before the Onset Of Symptoms May Improve ...mentioning

confidence: 96%

Secondary Brain Injury Following Neonatal Intraventricular Hemorrhage: The Role of the Ciliated Ependyma

Dawes

2022

Front. Pediatr.

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“…[54][55][56] A recent meta-analysis suggested that an early temporary neurosur-gical procedure led to significant reductions in the need for a ventriculoperitoneal shunt as well as in neurodevelopmental impairment. 57 For periventricular hemorrhagic infarction (PVHI), it is important to consider the site of the lesion; PVHI in the frontal or temporal lobes are rarely associated with cerebral palsy, and only half of those with PVHI in the parietal lobe develop contralateral cerebral palsy.…”

Section: Prediction Of Neurodevelopmental Outcome Using Cus Examinationmentioning

confidence: 99%

Neuroimaging of the Preterm Brain: Review and Recommendations

Inder

Vries

Ferriero

et al. 2021

The Journal of Pediatrics

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“…Meta-analyses suggest that VAD and VSGS are equivalent in terms of the risks, rates of subsequent need for permanent VP shunt and subsequent shunt revision rates, although earlier treatment is associated with lower rates of VP shunting and neurological disability [25][26][27]. Following institution of the temporising measures, ongoing monitoring with regular CrUS, head circumference measurement and clinical assessment are important to ensure ongoing control of the PHVD.…”

Section: Temporising Measuresmentioning

confidence: 99%

Intraventricular haemorrhage and posthaemorrhagic ventricular dilatation: moving beyond CSF diversion

et al. 2021

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Advances in medical care have led to more premature babies surviving the neonatal period. In these babies, germinal matrix haemorrhage (GMH), intraventricular haemorrhage (IVH) and posthaemorrhagic ventricular dilatation (PHVD) are the most important determinants of long-term cognitive and developmental outcomes. In this review, we discuss current neurosurgical management of IVH and PHVD, including the importance of early diagnosis of PHVD, thresholds for intervention, options for early management through the use of temporising measures and subsequent definitive CSF diversion. We also discuss treatment options for the evolving paradigm to manage intraventricular blood and its breakdown products. We review the evidence for techniques such as drainage, irrigation, fibrinolytic therapy (DRIFT) and neuroendoscopic lavage in the context of optimising cognitive, neurodevelopmental and quality of life outcomes in these premature infants.

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Timing of Temporizing Neurosurgical Treatment in Relation to Shunting and Neurodevelopmental Outcomes in Posthemorrhagic Ventricular Dilatation of Prematurity: A Meta-analysis

Cited by 16 publications

References 79 publications

Secondary Brain Injury Following Neonatal Intraventricular Hemorrhage: The Role of the Ciliated Ependyma

Secondary Brain Injury Following Neonatal Intraventricular Hemorrhage: The Role of the Ciliated Ependyma

Neuroimaging of the Preterm Brain: Review and Recommendations

Intraventricular haemorrhage and posthaemorrhagic ventricular dilatation: moving beyond CSF diversion

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