Does a temporizing measure of cerebrospinal fluid drainage as the initial procedure alter the surgical outcome in premature infants with post-hemorrhagic hydrocephalus?

Objective

It has been speculated whether the insertion of a temporary device to control hydrocephalus secondary to intraventricular hemorrhage (IVH) in the preterm neonate with removal of the debris caused by such a hemorrhage, can reduce subsequent complications following insertion of a permanent cerebrospinal fluid (CSF) diverting shunt. This retrospective review is directed at examining this speculation.

Methods

A retrospective review of the medical records of all premature infants surgically treated for post-hemorrhagic hydrocephalus (PHH) between 1997 and 2012 at our institution was undertaken.

Results

Over 14 years, 91 preterm infants with PHH were identified. The initial procedure for 50 neonates was the insertion of a ventricular reservoir (VR) that was serially tapped for varying time periods. For the remaining 41 premature infants, a ventriculoperitoneal/atrial shunt (VS) was the first procedure. Patients with a VR as their initial procedure underwent CSF diversion significantly earlier in life than those who had VS as the initial procedure (29 vs. 56 days, p < 0.01). Of the infants with a VR as their initial procedure, 5/50 (10%) did not undergo a subsequent VS. The number of shunt revisions and the rates of loculated hydrocephalus and shunt infection did not statistically differ between the two groups.

Conclusion

Patients with initial VR insertion received a CSF diversion procedure at a significantly younger age than those who received a permanent shunt as their initial procedure. Otherwise, the outcomes with regards to shunt revisions, loculated hydrocephalus, and shunt infection were not different for the two groups.