Korean J Neurotrauma.  2015 Oct;11(2):106-111. 10.13004/kjnt.2015.11.2.106.

Clinical Experience of Infantile Posthemorrhagic Hydrocephalus Treated with Ventriculo-Peritoneal Shunt

• Kim HM
• Kim KH

• KMID: 2378267
• DOI: http://doi.org/10.13004/kjnt.2015.11.2.106

Abstract

OBJECTIVE
Infantile posthemorrhagic hydrocephalus (IPHH) is the most common cause of infantile acquired hydrocephalus. We present and discuss our experience of treatment of six IPHH patients treated by a ventriculo-peritoneal (VP) shunt.
METHODS
Six preterm infants treated by a VP shunt due to germinal matrix hemorrhage and hydrocephalus were included in our study. External ventricular drainage (EVD) was performed in patients with symptomatic ventricular dilatation, and a VP shunt was placed in the case of no improvement of the ventricular index despite several rounds of EVD. Radiographic findings and surgical outcomes were analyzed retrospectively.
RESULTS
Four patients were male and two were female. Mean gestational age was 25 weeks and mean weight at birth was 868.3 g. One patient had a Papile grade II (16.7%) hemorrhage, three had a grade III (50%) hemorrhage, and two had a grade IV (33.3%) hemorrhage. EVD complications (one case of ventriculitis and one case of a ventricular abscess) occurred in two patients. VP shunt complications occurred in two patients (33.3%). Three cases had an isolated 4th ventricle; two of these cases had a VP shunt placed whereas the other case had a VP shunt placed in addition to aqueductoplasty using a neuroendoscope. At the last follow-up, three of the six patients had severe neurodevelopmental delay, two had mild neurodevelopmental delay, and one had normal development status.
CONCLUSION
In our study, although it is difficult to present the significant result for management of IPHH, we think that varied efforts are required to treat IPHH patients.

Keyword

Infant; Cerebrospinal fluid shunt; Hemorrhage; Hydrocephalus

MeSH Terms

Cerebrospinal Fluid Shunts
Dilatation
Drainage
Female
Follow-Up Studies
Gestational Age
Hemorrhage
Humans
Hydrocephalus*
Infant
Infant, Newborn
Infant, Premature
Male
Neuroendoscopes
Parturition
Retrospective Studies
Ventriculoperitoneal Shunt*

Figure

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  FIGURE 1 A case with complicated by proximal catheter occlusion. A: Ultrasonography taken seven days after birth shows intraventricular hemorrhage with dilatation of the lateral ventricle. B: Intraoperative neuroendoscopic view at the time of shunt revision shows encasement of choroid plexus around the intracranial catheter.

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  FIGURE 2 A case complicated by multiloculated ventricle. Multiple septations of lateral, 3rd, and 4th ventricle is shown in computed tomography (A, B). Sylvius aqueduct was reopened by a neuroendoscope (white arrow in C), and stent insertion into the Sylvius aqueduct is shown on the skull X-ray (white arrow in D).

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