Cao Guangna,Zhang Yang,Chang Yanmei,et al.Effect of ventriculosubgaleal shunts in the treatment of posthemorrhagic hydrocephalus of preterm infants[J].Journal of Clinical Pediatric Surgery,,21():242-247.[doi:10.3760/cma.j.cn101785-202106021-008]
Effect of ventriculosubgaleal shunts in the treatment of posthemorrhagic hydrocephalus of preterm infants
- Keywords:
- Hydrocephalus/SU; Drainage/MT; Infant; Premature; Feasibility Studies
- Abstract:
- Objective To explore the complications and clinical outcomes of ventriculosubgaleal(VSG) shunt in the treatment of posthemorrhagic hydrocephalus of preterm infants.Methods From November 2012 to November 2019, clinical data were retrospectively reviewed for 5 premature infants with posthemorrhagic hydrocephalus undergoing VSG shunt in neonatal intensive care unit.The changes of cerebrospinal fluid(CSF) protein, cell number and head circumference pre/post-VSG drainage were compared.The gestational age was(29.36±3.43) weeks and birth weight(1 560.00±665.85) grams.The operative age of VSG was(9-39) days with a median of 30(15-36) days.All etiologies were obstructive hydrocephalus secondary to intraventricular hemorrhage; Perinatal complications included asphyxia(n=2) and neonatal respiratory distress syndrome(n=3).There were patent ductus arteriosus(n=4), persistent pulmonary hypertension(n=3), septicemia(n=1) and respiratory acidosis(n=5).Results VSG shunt was performed 6 times.The duration of VSG drainage was(1-18) months with a median of 8.75(4-17.25) months.Compared with pre-VSG drainage, protein level of CSF declined gradually, count of CSF cells and head circumference decreased significantly.One case of temporary closure was re-operated after position adjusting.One case was blocked and no catheter-related infection or other complications occurred.During follow-ups, all of them survived.The outcomes were moderate mental retardation(n=1), mild mental retardation(n=1) and normal development(n=3).Conclusion VSG shunt is both safe and effective for premature hydrocephalus.Economical and convenient, it improves the prognosis and survival rate of children.The complications are fewer and controllable.
References:
[1] Fountain DM, Chari A, Allen D, et al.Comparison of the use of ventricular access devices and ventriculosubgaleal shunts in posthaemorrhagic hydrocephalus:systematic review and meta-analysis[J].Childs Nerv Syst, 2016, 32(2):259-267.DOI:10.1007/s00381-015-2951-8.
[2] Badhiwala JH, Hong CJ, Nassiri F, et al.Treatment of posthemorrhagic ventricular dilation in preterm infants:a systematic review and meta-analysis of outcomes and complications[J].J Neurosurg Pediatr, 2015, 16(5):545-555.DOI:10.3171/2015.3.PEDS14630.
[3] Shooman D, Portess H, Sparrow O.A review of the current treatment methods for posthaemorrhagic hydrocephalus of infants[J].Cerebrospinal Fluid Res, 2009, 6:1.DOI:10.1186/1743-8454-6-1.
[4] Valdez Sandoval P, Hernández Rosales P, Qui?ones Hernández DG, et al.Intraventricular hemorrhage and posthemorrhagic hydrocephalus in preterm infants:diagnosis, classification, and treatment options[J].Childs Nerv Syst, 2019, 35(6):917-927.DOI:10.1007/s00381-019-04127-x.
[5] 钟家斐, 纪新婷, 顾硕.综合征型脑积水的研究进展[J].临床小儿外科杂志, 2021, 20(3):285-291.DOI:10.12260/lcxewkzz.2021.03.016.Zhong JF, Ji XT, Gu S.Recent advances in diagnosis and treatment of syndromic hydrocephalus[J].J Clin Ped Sur, 2021, 20(3):285-291.DOI:10.12260/lcxewkzz.2021.03.016.
[6] Fulmer BB, Grabb PA, Oakes WJ, et al.Neonatal ventriculosubgaleal shunts[J].Neurosurgery, 2000, 47(1):80-84.DOI:10.1097/00006123-200007000-00018.
[7] Kutty RK, Sreemathyamma SB, Korde P, et al.Outcome of ventriculosubgaleal shunt in the management of infectious and non-infectious hydrocephalus in pre-term infants[J].J Pediatr Neurosci, 2018, 13(3):322-328.DOI:10.4103/JPN.JPN_41_18.
[8] Eid S, Iwanaga J, Oskouian RJ, et al.Ventriculosubgaleal shunting-a comprehensive review and over two-decade surgical experience[J].Childs Nerv Syst, 2018, 34(9):1639-1642.DOI:10.1007/s00381-018-3887-6.
[9] Nee LS, Harun R, Sellamuthu P, et al.Comparison between ventriculosubgaleal shunt and extraventricular drainage to treat acute hydrocephalus in adults[J].Asian J Neurosurg, 2017, 12(4):659-663.DOI:10.4103/ajns.AJNS_122_16.
[10] Inder TE, Perlman JM, Volpe JJ.Preterm intraventricular hemorrhage/posthemorrhagic hydrocephalus-sciencedirect[J].Volpe’s Neurology of the Newborn(Sixth Edition), 2018:637-698.
[11] Robinson S.Neonatal posthemorrhagic hydrocephalus from prematurity:pathophysiology and current treatment concepts[J].J Neurosurg Pediatr, 2012, 9(3):242-258.DOI:10.3171/2011.12.PEDS11136.
[12] Guo J, Chen Q, Tang J, et al.Minocycline-induced attenuation of iron overload and brain injury after experimental germinal matrix hemorrhage[J].Brain Res, 2015, 1594:115-124.DOI:10.1016/j.brainres.2014.10.046.
[13] 侯新琳.新生儿梗阻性脑积水的诊断与治疗[J].中国新生儿科杂志, 2014, 29(2):127-130.DOI:10.3969/j.issn.1673-6710.2014.02.016.Hou XL.Diagnosis and treatment of neonatal obstructive hydrocephalus[J].Chinese Journal of Neonatology, 2014, 29(2):127-130.DOI:10.3969/j.issn.1673-6710.2014.02.016.
[14] Whitelaw A, Aquilina K.Management of posthaemorrhagic ventricular dilatation[J].Arch Dis Child Fetal Neonatal Ed, 2012, 97(3):229-233.DOI:10.1136/adc.2010.190173.
[15] Taylor AG, Peter JC.Advantages of delayed VP shunting in post-haemorrhagic hydrocephalus seen in low-birth-weight infants[J].Childs Nerv Syst, 2001, 17(6):328-333.DOI:10.1007/s003810000429.
[16] Fulkerson DH, Vachhrajani S, Bohnstedt BN, et al.Analysis of the risk of shunt failure or infection related to cerebrospinal fluid cell count, protein level, and glucose levels in low-birth-weight premature infants with posthemorrhagic hydrocephalus[J].J Neurosurg Pediatr, 2011, 7(2):147-151.DOI:10.3171/2010.11.PEDS10244.
[17] Brouwer A, Groenendaal F, van Haastert IL, et al.Neurodevelopmental outcome of preterm infants with severe intraventricular hemorrhage and therapy for post-hemorrhagic ventricular dilatation[J].J Pediatr, 2008, 152(5):648-654.DOI:10.1016/j.jpeds.2007.10.005.
[18] Adams-Chapman I, Hansen NI, Stoll BJ, et al.NICHD Research Network.Neurodevelopmental outcome of extremely low birth weight infants with posthemorrhagic hydrocephalus requiring shunt insertion[J].Pediatrics, 2008, 121(5):e1167-e1177.DOI:10.1542/peds.2007-0423.
[19] Mazzola CA, Choudhri AF, Auguste KI, et al.Pediatric hydrocephalus:systematic literature review and evidence-based guidelines.Part 2:Management of posthemorrhagic hydrocephalus in premature infants[J].J Neurosurg Pediatr, 2014, 14(Suppl 1):8-23.DOI:10.3171/2014.7.PEDS14322.
[20] Karas CS, Baig MN, Elton SW.Ventriculosubgaleal shunts at columbus children’s hospital:neurosurgical implant placement in the neonatal intensive care unit[J].J Neurosurg, 2007, 107(3 Suppl):220-223.DOI:10.3171/PED-07/09/220.
[21] Seeburg D, Ahn E, Huisman T.Secondary pediatric encephalocele after ventriculosubgaleal shunting for posthemorrhagic hydrocephalus[J].Neuropediatrics, 2014, 45(4):252-255.DOI:10.1055/s-0033-1363298.
[22] Tubbs RS, Banks JT, Soleau S, et al.Complications of ventriculosubgaleal shunts in infants and children[J].Childs Nerv Syst, 2005, 21(1):48-51.DOI:10.1007/s00381-004-0967-6.
[23] Ozerov S, Thomale UW, Schulz M, et al.The use of a smartphone-assisted ventricle catheter guide for Ommaya reservoir placement-experience of a retrospective bi-center study[J].Childs Nerv Syst, 2018, 34(5):853-859. DOI:10.1007/s00381-017-3713-6.
[24] 许新科, 李方成.关于儿童脑肿瘤手术治疗的认识与思考[J].临床小儿外科杂志, 2021, 20(5):405-408.DOI:10.12260/lcxewkzz.2021.05.002.Xu XK, Li FC.Understandings and thoughts of surgery for brain tumors in children[J].J Clin Ped Sur, 2021, 20(5):405-408.DOI:10.12260/lcxewkzz.2021.05.002.
[25] Wellons JC, Shannon CN, Kulkarni AV, et al.A multicenter retrospective comparison of conversion from temporary to permanent cerebrospinal fluid diversion in very low birth weight infants with posthemorrhagic hydrocephalus[J].J Neurosurg Pediatr, 2009, 4(1):50-55.DOI:10.3171/2009.2.PEDS08400.
[26] Limbrick DD Jr, Mathur A, Johnston JM, et al.Neurosurgical treatment of progressive posthemorrhagic ventricular dilation in preterm infants:a 10-year single-institution study[J].J Neurosurg Pediatr, 2010, 6(3):224-230.DOI:10.3171/2010.5.PEDS1010.
[27] Kariyattil R, Mariswamappa K, Panikar D.Ventriculosubgaleal shunts in the management of infective hydrocephalus[J].Childs Nerv Syst, 2008, 24(9):1033-1035.DOI:10.1007/s00381-008-0628-2.
[28] Lam HP, Heilman CB.Ventricular access device versus ventriculosubgaleal shunt in post hemorrhagic hydrocephalus associated with prematurity[J].J Matern Fetal Neonatal Med, 2009, 22(11):1097-1101.DOI:10.3109/14767050903029576.
[29] Sil K, Ghosh SK, Chatterjee S.Ventriculo-subgaleal shunts-broadening the horizons:an institutional experience[J].Childs Nerv Syst, 2021, 37(4):1113-1119.DOI:10.1007/s00381-020-04929-4.
Memo
收稿日期:2021-06-09。
基金项目:国家自然科学基金(31830034)
通讯作者:常艳美,Email:changyanmei0410@sina.com