A multicenter retrospective comparison of conversion from temporary to permanent cerebrospinal fluid diversion in very low birth weight infants with posthemorrhagic hydrocephalus

Clinical article

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  • 1 Section of Pediatric Neurosurgery, Children's Hospital of Alabama, Division of Neurosurgery, University of Alabama at Birmingham, Alabama;
  • 2 Division of Neurosurgery, Hospital for Sick Children, Toronto, Canada;
  • 3 Department of Pediatrics, Division of Inpatient Medicine, University of Utah, Salt Lake City;
  • 4 Division of Pediatric Neurosurgery, Primary Children's Hospital, Department of Neurosurgery, University of Utah, Salt Lake City, Utah; and
  • 5 Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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Object

The purpose of this study was to define the incidence of permanent shunt placement and infection in patients who have undergone the 2 most commonly performed temporizing procedures for posthemorrhagic hydrocephalus (PHH) of prematurity: ventriculosubgaleal (VSG) shunt placement and ventricular reservoir placement for intermittent tapping.

Methods

The 4 centers of the Hydrocephalus Clinical Research Network participated in a retrospective chart review of infants with PHH who underwent treatment at each institution between 2001 and 2006. Patients were included if they had received a diagnosis of Grade 3 or 4 intraventricular hemorrhage, weighed < 1500 g at birth, and had received surgical intervention. The authors determined the incidence of conversion from a temporizing device to a permanent shunt, the incidence of CSF infection during temporization, and the 6-month CSF infection rate after permanent shunt placement.

Results

Thirty-one (86%) of 36 patients who received VSG shunts and 61 (69%) of 88 patients who received ventricular reservoirs received permanent CSF diversion with a shunt (p = 0.05). Five patients (14%) in the VSG shunt group had CSF infections during temporization, compared with 11 patients (13%) in the ventricular reservoir group (p = 0.83). The 6-month incidence of permanent shunt infection in the VSG shunt group was 16% (5 of 31), compared with 12% (7 of 61) in the reservoir placement group (p = 0.65). For the first 6 months after permanent shunt placement, infants with no preceding temporizing procedure had an infection rate of 5% (1 of 20 infants) and those who had undergone a temporizing procedure had an infection rate of 13% (12 of 92; p = 0.45).

Conclusions

The use of intermittent tapping of ventricular reservoirs in this population appears to lead to a lower incidence of permanent shunt placement than the use of VSG shunts. The incidence of infection during temporization and for the initial 6 months after conversion appears comparable for both groups. The apparent difference identified in this pilot study requires confirmation in a more rigorous study.

Abbreviations used in this paper: HCRN = Hydrocephalus Clinical Research Network; IVH = intraventricular hemorrhage; PHH = posthemorrhagic hydrocephalus; VP = ventriculoperitoneal; VSG = ventriculosubgaleal.

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Contributor Notes

Address correspondence to: John C. Wellons III, M.D., Children's Hospital of Alabama, 1600 7th Avenue South, ACC 400 Birmingham, Alabama 35233. email: jay.wellons@ccc.uab.edu.
  • 1

    Adams-Chapman I, , Hansen NI, , Stoll BJ, & Higgins R: Neurodevelopmental outcome of extremely low birth weight infants with posthemorrhagic hydrocephalus requiring shunt insertion. Pediatrics 121:e1167e1177, 2008

    • Search Google Scholar
    • Export Citation
  • 2

    Brouwer AJ, , Groenendaal F, , van den Hoogen A, , Verboon-Maciolek M, , Hanlo P, & Rademaker KJ, : Incidence of infections of ventricular reservoirs in the treatment of post-haemorrhagic ventricular dilatation: a retrospective study (1992–2003). Arch Dis Child Fetal Neonatal Ed 92:F41F43, 2007

    • Search Google Scholar
    • Export Citation
  • 3

    de Vries LS, , Liem KD, , van Dijk K, , Smit BJ, , Sie L, & Rademaker KJ, : Early versus late treatment of posthaemorrhagic ventricular dilatation: results of a retrospective study from five neonatal intensive care units in The Netherlands. Acta Paediatr 91:212217, 2002

    • Search Google Scholar
    • Export Citation
  • 4

    Gaskill SJ, , Marlin AE, & Rivera S: The subcutaneous ventricular reservoir: an effective treatment for posthemorrhagic hydrocephalus. Childs Nerv Syst 4:291295, 1988

    • Search Google Scholar
    • Export Citation
  • 5

    Griebel R, , Khan M, & Tan L: CSF shunt complications: an analysis of contributory factors. Childs Nerv Syst 1:7780, 1985

  • 6

    Gurtner P, , Bass T, , Gudeman SK, , Penix JO, , Philput CB, & Schinco FP: Surgical management of posthemorrhagic hydrocephalus in 22 low-birth-weight infants. Childs Nerv Syst 8:198202, 1992

    • Search Google Scholar
    • Export Citation
  • 7

    Hintz SR, , Poole WK, , Wright LL, , Fanaroff AA, , Kendrick DE, & Laptook AR, : Changes in mortality and morbidities among infants born at less than 25 weeks during the postsurfactant era. Arch Dis Child Fetal Neonatal Ed 90:F128F133, 2005

    • Search Google Scholar
    • Export Citation
  • 8

    Hudgins RJ, , Boydston WR, , Hudgins PA, & Adler SR: Treatment of intraventricular hemorrhage in the premature infant with urokinase. A preliminary report. Pediatr Neurosurg 20:190197, 1994

    • Search Google Scholar
    • Export Citation
  • 9

    Levy ML, , Masri LS, & McComb JG: Outcome for preterm infants with germinal matrix hemorrhage and progressive hydrocephalus. Neurosurgery 41:11111118, 1997

    • Search Google Scholar
    • Export Citation
  • 10

    Liptak GS, & McDonald JV: Ventriculoperitoneal shunts in children: factors affecting shunt survival. Pediatr Neurosci 12:289293, 1985

  • 11

    McComb JG, , Ramos AD, , Platzker AC, , Henderson DJ, & Segall HD: Management of hydrocephalus secondary to intraventricular hemorrhage in the preterm infant with a subcutaneous ventricular catheter reservoir. Neurosurgery 13:295300, 1983

    • Search Google Scholar
    • Export Citation
  • 12

    McGirt MJ, , Leveque JC, , Wellons JC III, , Villavicencio AT, , Hopkins JS, & Fuchs HE, : Cerebrospinal fluid shunt survival and etiology of failures: a seven-year institutional experience. Pediatr Neurosurg 36:248255, 2002

    • Search Google Scholar
    • Export Citation
  • 13

    National Institute of Neurologic Disorders and Stroke: Hydrocephalus: Myths, New Facts, Clear Directions Bethesda, MD, NINDS, 2005. (http://www.ninds.nih.gov/news_and_events/proceedings/Hydrocephalus_2005.htm) [Accessed 13 March 2009]

    • Search Google Scholar
    • Export Citation
  • 14

    Peretta P, , Ragazzi P, , Carlino CF, , Gaglini P, & Cinalli G: The role of Ommaya reservoir and endoscopic third ventriculostomy in the management of post-hemorrhagic hydrocephalus of prematurity. Childs Nerv Syst 23:765771, 2007

    • Search Google Scholar
    • Export Citation
  • 15

    Perret GE, & Graf CJ: Subgaleal shunt for temporary ventricle decompression and subdural drainage. J Neurosurg 47:590595, 1977

  • 16

    Piatt JH Jr, & Carlson CV: A search for determinants of cerebrospinal fluid shunt survival: retrospective analysis of a 14-year institutional experience. Pediatr Neurosurg 19:233242, 1993

    • Search Google Scholar
    • Export Citation
  • 17

    Rahman S, , Teo C, , Morris W, , Lao D, & Boop FA: Ventriculosubgaleal shunt: a treatment option for progressive posthemorrhagic hydrocephalus. Childs Nerv Syst 11:650654, 1995

    • Search Google Scholar
    • Export Citation
  • 18

    Richard E, , Cinalli G, , Assis D, , Pierre-Kahn A, & Lacaze-Masmonteil T: Treatment of post-haemorrhage ventricular dilatation with an Ommaya's reservoir: management and outcome of 64 preterm infants. Childs Nerv Syst 17:334340, 2001

    • Search Google Scholar
    • Export Citation
  • 19

    Tubbs RS, , Smyth MD, , Wellons JC III, , Blount JP, , Grabb PA, & Oakes WJ: Life expectancy of ventriculosubgaleal shunt revisions. Pediatr Neurosurg 38:244246, 2003

    • Search Google Scholar
    • Export Citation
  • 20

    Tuli S, , Drake J, , Lawless J, , Wigg M, & Lamberti-Pasculli M: Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus. J Neurosurg 92:3138, 2000

    • Search Google Scholar
    • Export Citation
  • 21

    Ventriculomegaly Trial Group: Randomised trial of early tapping in neonatal posthaemorrhagic ventricular dilatation. Arch Dis Child 65:310, 1990

    • Search Google Scholar
    • Export Citation
  • 22

    Whitelaw A: Repeated lumbar or ventricular punctures in newborns with intraventricular hemorrhage. Cochrane Database Syst Rev 1:CD000216, 2001

    • Search Google Scholar
    • Export Citation
  • 23

    Whitelaw A, , Kennedy CR, & Brion LP: Diuretic therapy for newborn infants with posthemorrhagic ventricular dilatation. Cochrane Database Syst Rev 2:CD002270, 2001

    • Search Google Scholar
    • Export Citation
  • 24

    Whitelaw A, & Odd DE: Intraventricular streptokinase after intraventricular hemorrhage in newborn infants. Cochrane Database Syst Rev 4:CD000498, 2007

    • Search Google Scholar
    • Export Citation
  • 25

    Whitelaw A, , Pople I, , Cherian S, , Evans D, & Thoresen M: Phase 1 trial of prevention of hydrocephalus after intraventricular hemorrhage in newborn infants by drainage, irrigation, and fibrinolytic therapy. Pediatrics 111:759765, 2003

    • Search Google Scholar
    • Export Citation
  • 26

    Willis BK, , Kumar CR, , Wylen EL, & Nanda A: Ventriculosubgaleal shunts for posthemorrhagic hydrocephalus in premature infants. Pediatr Neurosurg 41:178185, 2005

    • Search Google Scholar
    • Export Citation

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