Ventriculoperitoneal Shunts in Low Birth Weight Infants with Intracranial Hemorrhage: Neurodevelopmental outcome

Boynton, Bruce R.; Boynton, Carole A.; Merritt, T. Allen; Vaucher, Yvonne E.; James, Hector E.; Bejar, Raul

doi:10.1007/978-3-662-11149-9_79

Cited by 27 publications

(38 citation statements)

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“…Many studies have shown that the complication rate of ventriculoperitoneal shunts in the PHHP population is higher than that in patients with hydrocephalus from other etiologies. 1,3 The success rate of ETV/CPC in children younger than 2 years varies from less than 50% to as high as 80% depending on the etiology of hydrocephalus. 1,4,13 In a large cohort of Ugandan children with postinfectious hydrocephalus, Warf found that adding CPC to ETV increased the success rate from 47% to 66%.…”

mentioning

confidence: 99%

Endoscopic third ventriculostomy and choroid plexus cauterization in posthemorrhagic hydrocephalus of prematurity

Chamiraju

Bhatia

Sandberg

et al. 2014

PED

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Object The aim of this study was to determine the role of endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC) in the management of posthemorrhagic hydrocephalus of prematurity (PHHP) and to analyze which factors affect patient outcomes. Methods This study retrospectively reviewed medical records of 27 premature infants with intraventricular hemorrhage (IVH) and hydrocephalus treated with ETV and CPC from 2008 to 2011. All patients were evaluated using MRI before the procedure to verify the anatomical feasibility of ETV/CPC. Endoscopic treatment included third ventriculostomy, septostomy, and bilateral CPC. After ETV/CPC, all patients underwent follow-up for a period of 6–40 months (mean 16.2 months). The procedure was considered a failure if the patient subsequently required a shunt. The following factors were analyzed to determine a relationship to patient outcomes: gestational age at birth, corrected age and weight at surgery, timing of surgery after birth, grade of IVH, the status of the prepontine cistern and cerebral aqueduct on MRI, need for a ventricular access device prior to the endoscopic procedure, and scarring of the prepontine cistern noted at surgery. Results Seventeen (63%) of 27 patients required a shunt after ETV/CPC, and 10 patients did not require further CSF diversion. Several factors studied were associated with a higher rate of ETV/CPC failure: Grade IV hemorrhage, weight 3 kg or less and age younger than 3 months at the time of surgery, need for reservoir placement, and presence of a normal cerebral aqueduct. Two factors were found to be statistically significant: the patient's corrected gestational age of less than 0 weeks at surgery and a narrow prepontine cistern on MRI. The majority (83%) of ETV/CPC failures occurred in the first 3 months after the procedure. None of the patients had a complication directly related to the procedure. Conclusions Endoscopic third ventriculostomy/CPC is a safe initial procedure for hydrocephalus in premature infants with IVH and hydrocephalus, obviating the need for a shunt in selected patients. Even though the success rate is low (37%), the lower rate of complications in comparison with shunt treatment may justify this procedure in the initial management of hydrocephalus. As several of the studied factors have shown influence on the outcome, patient selection based on these observations might increase the success rate.

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confidence: 99%

Endoscopic third ventriculostomy and choroid plexus cauterization in posthemorrhagic hydrocephalus of prematurity

Chamiraju

Bhatia

Sandberg

et al. 2014

PED

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“…Después de repasar las distintas alternativas de tratamiento de la HPH del prematuro se comprueba que, en el momento actual, no existe ninguna que sea ideal o que pueda ser considerada de elección. Frecuentemente, como mejor alternativa, el neurocirujano tiene que recurrir a la derivación de LCR en pacientes considerados clásicamente malos candidatos a cirugía por el alto índice de complicaciones esperables, no existiendo ni siquiera acuerdo en cuanto al peso mínimo necesario para la intervención 2,3,12,14 . El desarrollo de sistemas derivativos de menor tamaño y quizá el uso de catéteres con impregnación antibiótica han contribuido a disminuir la morbi-mortalidad del procedimiento 13 .…”

Section: Discussionunclassified

“…Opciones ampliamente utilizadas durante años como las punciones lumbares o ventriculares precoces y repetidas o el uso de fibrinolisis intraventricular se han mostrado ineficaces a la hora de reducir la discapacidad, la necesidad de derivación licuoral o la mortalidad en estos pacientes, y además pueden tener efectos adversos importantes 15,16,17,18 . En ocasiones, como única alternativa, el neurocirujano tiene que recurrir a la derivación de LCR en pacientes considerados clásicamente malos candidatos a cirugía por el alto índice de complicaciones esperables, no existiendo ni siquiera acuerdo en cuanto al peso mínimo necesario para la intervención 2,3,12,14 . En la práctica habitual el interés del neurocirujano se centra en el seguimiento de aspectos relacionados con la cirugía, con poco énfasis en el pronóstico funcional.…”

Section: Introductionunclassified

Hemorragia intraventricular del prematuro e hidrocefalia post-hemorrágica: Propuesta de un protocolo de manejo basado en la derivación ventrículo-peritoneal precoz

et al. 2009

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“…Neurodevelopmental outcome is thought to be poor. With regard to neonatal prognosis, Boynton et al 12 reported outcomes of 50 preterm neonates with posthemorrhagic hydrocephalus. The mortality rate was 7%; seizures developed in 38% of the patients; and limitations in motor function developed in 49%.…”

Section: 2mentioning

confidence: 99%

“…The mortality rate was 7%; seizures developed in 38% of the patients; and limitations in motor function developed in 49%. 12 There have been some reports about hydrocephalus caused by alloimmune thrombocytopenia, but hydrocephalus occurring after intracranial hemorrhage in fetuses of mothers with ITP has rarely been reported. In 1985, Morales and Stroup 13 reported 1 case of intracranial hemorrhage in utero that developed in a neonate with isoimmune thrombocytopenia and commented that a similar condition can arise from maternal ITP.…”

Section: 2mentioning

confidence: 99%

Fetal Hydrocephalus in a Pregnancy Complicated by Idiopathic Thrombocytopenic Purpura

Kim

Choi

2006

J of Ultrasound Medicine

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diopathic thrombocytopenic purpura (ITP) is an autoimmune disorder in which the platelets of patients are destroyed by autoantibodies. It commonly affects young women, and obstetricians frequently come across these patients. There have been concerns about whether vaginal delivery may predispose the fetus to intracranial hemorrhage, and it has led many obstetricians to use cesarean delivery to prevent intracranial bleeding. The incidence of intracranial hemorrhage, however, in neonates born to the mother with ITP has been reported to be less than 1%. Moreover, intrauterine intracranial hemorrhage regardless of mechanical stress at delivery seems to be very rare. We report a pregnancy complicated by ITP in which intrauterine intracranial hemorrhage was diagnosed prenatally in the third trimester.

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Ventriculoperitoneal Shunts in Low Birth Weight Infants with Intracranial Hemorrhage: Neurodevelopmental outcome

Cited by 27 publications

References 0 publications

Endoscopic third ventriculostomy and choroid plexus cauterization in posthemorrhagic hydrocephalus of prematurity

Endoscopic third ventriculostomy and choroid plexus cauterization in posthemorrhagic hydrocephalus of prematurity

Hemorragia intraventricular del prematuro e hidrocefalia post-hemorrágica: Propuesta de un protocolo de manejo basado en la derivación ventrículo-peritoneal precoz

Fetal Hydrocephalus in a Pregnancy Complicated by Idiopathic Thrombocytopenic Purpura

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