A Two-Step Therapeutic Strategy in the Management of Critical Neonatal Hydrocephalus.

Abstract

Aim: To identify novel therapeutic strategies to improve the outcomes of neonatal hydrocephalus.

Material and methods: The treatment strategies for cases of neonatal hydrocephalus in our hospital between February 1, 2015, and February 1, 2024 reviewed and analyzed, with the aim of identifying valuable factors to assist in treating future patients with critical neonatal hydrocephalus. We further conducted literature searches and summarized the relevant treatment strategies.

Results: A total of 64 neonates were included. The causes of hydrocephalus by case number were as follows: 59.1% due to cerebral hemorrhage, 24.0% due to intracranial infection, and 16.9% due to other causes. Additionally, 32.8% of patients had ultra-low birth weight (ULBW), 14.1% had very low birth weight (VLBW), and 53.1% had low birth weight (LBW). Preterm babies comprised 84.3% of all patients, whereas term babies comprised only 15.7%. Additionally, all treatments for patients involved surgery, with 3.06% undergoing endoscopic third ventriculostomy (ETV), 29.59% undergoing ventriculoperitoneal shunt (VPS), 32.65% undergoing extra-ventricular drainage (EVD), 1.53% undergoing ventriculoatrial shunt (VAS), and 20.41% undergoing Ommaya reservoir. Based on the collected information, we propose a novel two-step surgical treatment process for intensive neonatal hydrocephalus. In the first step, the patient?s physical status (weight and corrected gestational age) is improved and intracranial infection or bleeding are controlled. In the second step, a permanent shunt is placed once the patient meets the surgical criteria.

Conclusion: Based on our experience, we proposed a two-step treatment strategy for the surgical management of critical neonatal hydrocephalus. Moreover, we clarified the detailed criteria for each step of the treatment plan to promote a higher success rate in saving children?s lives. The prognosis of critical neonatal hydrocephalus can be favorable if appropriately treated.