[Surgical treatment of posthemorrhagic hydrocephalus in premature infants].

Abstract

Rationale: Hydrocephalus as a consequence of intraventricular hemorrhage (IVH) in premature infants is a life-threatening complication of the neonatal period. The question remains as to which methods are best to be used for temporary drainage of cerebrospinal fluid until sufficient body mass for possible shunt implantation is achieved.

Objective: Is to compare four methods of temporary treatment of posthemorrhagic hydrocephalus in terms of their safety and effectiveness.

Material and methods: A multicenter (12 healthcare facilities of the Russian Federation) prospective study included 165 premature infants with IVH and signs of worsening enlargement of the ventricles. External ventricular drainage (EVD) was used in 43 observations, ventriculosubgaleal shunt (VSGS) in 93 observations, neuroendoscopic lavage (NEL) in 25 observations and Ommaya reservoir - in 4. Methods were compared by effectiveness and postoperative complications. The examination of patients in catamnesis was carried out at the age of 6, 12, 24 and 36 months.

Results: Differences regarding brain tissue defect in the access zone (the highest in the NEL group and the lowest in EVD group, p<0.001); multilocular hydrocephalus frequency (the highest in the EVD group - 33% and the lowest in the NEL group - 17%, p<0.05); proportion of patients in need of permanent shunting (the highest indicator in the VSGS group - 88.1% and the lowest in the NEL group - 57%, p<0.001); number of infectious complications (most of all in the EVD group - 12%, the lowest in the NEL group - 0%) have been revealed. The best indicators of children's motor development have been noted in the NEL group (2.25), the worst in the EVD group - 3.75. Long-term mortality in the distant period amounted to 7%.

Conclusion: The most effective method of temporary arresting of hydrocephalus is neuroendoscopic lavage. It has a minimal number of infectious and other complications, the best hydrocephalus stabilization, low percentage of complicated hydrocephalus (multilocular) and the best motor development indicators and does not require reinterventions.