Posthemorrhagic hydrocephalus in very low birth weight infants—a new gentle surgical technique for external ventricular drainage

• Published in: Child's nervous system Vol. 27; no. 6; pp. 991 - 994
• Main Authors: Januschek, Elke, Singh Machado, Lisa, Steinthal, Barbara, Ulrich, Peter T.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-06-2011
• Subjects: Cerebral Hemorrhage - complications; Cerebral Hemorrhage - surgery; Cerebral Ventricles - pathology; Cerebral Ventricles - surgery; Cerebrospinal Fluid Shunts - instrumentation; Cerebrospinal Fluid Shunts - methods; Drainage - methods; Humans; Hydrocephalus - etiology; Hydrocephalus - surgery; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Very Low Birth Weight; Medicine; Medicine & Public Health; Neurosciences; Neurosurgery; Neurosurgical Procedures - instrumentation; Neurosurgical Procedures - methods; Technical Note; Posthemorrhagic hydrocephalus; External ventricular drainage; Infants
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-011-1413-1

Objective
The germinal matrix hemorrhage in premature infants is related to the immaturity of the subependymal vascular bed. Posthemorrhagic ventricular dilation (PVD) in extremely low birth weight infants (ELBI) is a medical challenge and is associated with a high risk of long-term disability. Our aim was to find a safe and gentle surgical technique for external ventricular drainage implantation for this patient population.
Patients and methods
We implanted eight external ventricular drainages in ELBI with birth weights ranging from 479 to 884 g (24 to 27 weeks gestational age) and a grade III to IV hemorrhage, who developed a PVD soon after birth. A replacement of the drainage was required three times in one infant with a birth weight of 479 g. Due to the subcutaneous tunneling and drawing of the catheter through the sleeve, the skin contact remains slight, and thus, infections are avoided.
Results
There were no complications during the procedures which can also be carried out in the neonatal intensive care unit. Only in one case (479 g birth weight and severe concomitant diseases) was an infection observed, though the origin was most likely abdominal. In the same case, a temporary leakage was treated by suture. This patient died of non-neurological complications related to the patient's prematurity. Three of the five preterms were shunted over time.
Conclusions
Although there is only a small number of extremely low birth weight infants with posthemorrhagic hydrocephalus who were treated with this technique, our findings suggest that this method is very safe and useful. It reduces the risk of infection and cerebrospinal fluid leaks and might be a better alternative to serial lumbar or transfontanel punctures in extremely low birth weight infants for bridging the first weeks of life.