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Sewell E, Cohen S, Zaniletti I, Couture D, Dereddy N, Coghill CH, Flanders TM, Foy A, Heuer GG, Jano E, Kemble N, Lee S, Ling CY, Malaeb S, Mietzsch U, Ocal E, Padula MA, Welch CD, White B, Wilson D, Flibotte J. Surgical interventions and short-term outcomes for preterm infants with post-haemorrhagic hydrocephalus: a multicentre cohort study. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-327084. [PMID: 38697810 DOI: 10.1136/archdischild-2024-327084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE To (1) describe differences in types and timing of interventions, (2) report short-term outcomes and (3) describe differences among centres from a large national cohort of preterm infants with post-haemorrhagic hydrocephalus (PHH). DESIGN Cohort study of the Children's Hospitals Neonatal Database from 2010 to 2022. SETTING 41 referral neonatal intensive care units (NICUs) in North America. PATIENTS Infants born before 32 weeks' gestation with PHH defined as acquired hydrocephalus with intraventricular haemorrhage. INTERVENTIONS (1) No intervention, (2) temporising device (TD) only, (3) initial permanent shunt (PS) and (4) TD followed by PS (TD-PS). MAIN OUTCOME MEASURES Mortality and meningitis. RESULTS Of 3883 infants with PHH from 41 centres, 36% had no surgical intervention, 16% had a TD only, 19% had a PS only and 30% had a TD-PS. Of the 46% of infants with TDs, 76% were reservoirs; 66% of infants with TDs required PS placement. The percent of infants with PHH receiving ventricular access device placement differed by centre, ranging from 4% to 79% (p<0.001). Median chronological and postmenstrual age at time of TD placement were similar between infants with only TD and those with TD-PS. Infants with TD-PS were older and larger than those with only PS at time of PS placement. Death before NICU discharge occurred in 12% of infants, usually due to redirection of care. Meningitis occurred in 11% of the cohort. CONCLUSIONS There was significant intercentre variation in rate of intervention, which may reflect variability in care or referral patterns. Rate of PS placement in infants with TDs was 66%.
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Affiliation(s)
- Elizabeth Sewell
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA
| | - Susan Cohen
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | | - Dan Couture
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Narendra Dereddy
- AdventHealth for Children, Orlando, Florida, USA
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Carl H Coghill
- Children's of Alabama, Birmingham, Alabama, USA
- The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Tracy M Flanders
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Andrew Foy
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Gregory G Heuer
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Eni Jano
- Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Nicole Kemble
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Stephanie Lee
- University of Iowa Health Care, Iowa City, Iowa, USA
| | - Con Yee Ling
- The University of Utah School of Medicine, Salt Lake City, Utah, USA
- Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Shadi Malaeb
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Ulrike Mietzsch
- Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eylem Ocal
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Michael A Padula
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Cherrie D Welch
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Diane Wilson
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John Flibotte
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Bleil C, Vitulli F, Mirza AB, Boardman TM, Al Banna Q, AlFaiadh W, Zebian B. Ventriculosubgaleal shunts in the management of neonatal post-haemorrhagic hydrocephalus: technical note. Childs Nerv Syst 2023; 39:3263-3271. [PMID: 37584741 DOI: 10.1007/s00381-023-06125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION Germinal matrix / intraventricular haemorrhage (GMIVH) remains a significant complication of prematurity. The more severe grades are associated with parenchymal haemorrhagic infarction (PHI) and hydrocephalus. A temporising procedure is usually the first line in management of neonatal post-haemorrhagic hydrocephalus (nPHH) as the risk of failure of a permanent cerebrospinal fluid (CSF) diversion is higher in the early stage. Our choice of temporising procedure is a ventriculosubgaleal shunt (VSGS). In this technical note, we describe a modification in technique whereby the pocket of the VSGS is fashioned away from the surgical wound. This resulted in lower CSF leak and subsequent infection rates in our centre. METHODS We conducted a retrospective analysis of all patients who underwent insertion of a VSGS between September 2014 and February 2023. RESULTS Twenty children were included in our study with a mean gestational age of 31 weeks + 4 days. Post-operatively, 10% of patients did not need a tap, and 10%, 20%, 15%, 25% and 20% respectively had 1, 2, 3, 4 and 5 taps. Two patients experienced CSF leak from their wounds. In both these patients, the pocket was deemed too close to the wound. None of the patients without suspected pre-existing CNS infection at the time of insertion of VSGS had a subsequent VSGS-related infection. VSGS conversion to permanent ventriculoperitoneal shunts (VPS) was required in 15 (75%) of the patients with an average interval duration of 72 days. On reviewing the literature, the infection rate following VSGS is quoted up to 13.5%. In our own centre, 13 patients had undergone VSGS insertion between 2005 and 2013 with a 30.8% infection rate which seemed related to increased leak rates. CONCLUSION Our modified surgical approach seems to be effective in reducing the risk of infection, which we postulate is a direct result of reduction in the risk of leak from the surgical wound.
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Affiliation(s)
- Cristina Bleil
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Francesca Vitulli
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II" University of Naples, Via Sergio Pansini n.5, 80131, Naples, Italy.
| | - Asfand Baig Mirza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | | | - Qusai Al Banna
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Wisam AlFaiadh
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Bassel Zebian
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
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Miranda P, Simal JA, Plaza E, Pancucci G, Escrig R, Boronat N, Llorens R. Preterm-related posthemorrhagic hydrocephalus: Review of our institutional series with a long-term follow-up. NEUROCIRUGIA (ENGLISH EDITION) 2023; 34:122-127. [PMID: 36774256 DOI: 10.1016/j.neucie.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/05/2022] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Preterm-related posthemorrhagic hydrocephalus is a major cause of neurological impairment and a common indication for a ventriculoperitoneal shunt in infants that are prone to diverse complications. Protocols of diagnosis and treatment are in continuous evolution and require evaluation of their results. OBJECTIVE To review the clinical characteristics and results of a series of preterm-related posthemorrhagic hydrocephalus needing a definitive shunt from 1982 to 2020 in our institution. As a secondary objective we evaluated the safety of the changes in our protocol of treatment from 2015. METHODS Retrospective review, clinical investigation. RESULTS 133 patients were implanted a shunt in the study period. Shunt infection was diagnosed in 15 patients. Proximal shunt obstruction as the first complication was diagnosed in 30% of cases at one year, 37% at two years and 46% at five years. 61 patients developed very small or collapsed ventricles at last follow-up. Two thirds of our patients achieved normal neurological development or mild impairment. Changes in protocol did not significantly modify clinical results although improvement in most outcomes was observed. Mean follow-up was over nine years. CONCLUSIONS Clinical outcomes are comparable to previous reported data. Changes in protocol proved to be safe and improved our results. Programmable shunts can be used safely in preterm patients although they may not prevent tendency towards ventricular collapse, which is very common after long follow-up.
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Affiliation(s)
- Pablo Miranda
- Servicio de Neurocirugía, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - Juan Antonio Simal
- Servicio de Neurocirugía, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Estela Plaza
- Servicio de Neurocirugía, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Giovanni Pancucci
- Servicio de Neurocirugía, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Raquel Escrig
- Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Nuria Boronat
- Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Roberto Llorens
- Servicio de Radiología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Wu Y, Liang P, Li L, Zhou Y, Wang D, Zhai X. Neurodevelopmental outcomes of neonatal posthemorrhagic hydrocephalus and psychological effects on the parents. Childs Nerv Syst 2023:10.1007/s00381-023-05935-y. [PMID: 37081233 PMCID: PMC10390597 DOI: 10.1007/s00381-023-05935-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 03/16/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Neonatal posthemorrhagic hydrocephalus remains a common complication in preterm infants, with high rates of mortality and morbidity, placing parents at high risk of anxiety and depression. We sought to investigate the neurodevelopmental outcomes of infants with posthemorrhagic hydrocephalus who underwent surgery and the psychological effect on their parents. METHODS We retrospectively analysed all infants with posthemorrhagic hydrocephalus born between 2014 and 2020 in the Children's Hospital of Chongqing Medical University, China. The neurodevelopmental outcomes of 28 patients were evaluated by the Pediatric Stroke Outcome Measure score, and the psychological states of the parents of survivors were assessed by the Hospital Anxiety and Depression Scale. RESULTS The families of the 28 patients were followed up for a median duration of 3 years; 6 (21.4%) patients died within 6 months after discharge, 12 (42.9%) patients had moderate to severe dysfunction, and only 10 (35.7%) patients had good outcomes. Regarding the 22 parents of the survivors, 5 (22.7%) and 4 (18.2%) had borderline anxiety and depression symptoms, respectively. Two (9.1%) caregivers had exact anxiety and depression symptoms. Leukomalacia after intraventricular haemorrhage was associated with adverse neurological outcomes. The infants' histories of epileptic seizures during the neonatal period were associated with the anxiety of their parents. CONCLUSION The overall outcome of posthemorrhagic hydrocephalus patients is unsatisfactory, and children with leukomalacia after haemorrhage tend to have poor outcomes. A history of epileptic seizures during the course of the disease may exacerbate the anxiety of the caregivers.
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Affiliation(s)
- Yuxin Wu
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400010, China
| | - Ping Liang
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400010, China
| | - Lusheng Li
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400010, China
| | - Yudong Zhou
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400010, China
| | - Difei Wang
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400010, China
| | - Xuan Zhai
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400010, China.
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Liu G, Nie C. Ultrasonic Diagnosis and Management of Posthemorrhagic Ventricular Dilatation in Premature Infants: A Narrative Review. J Clin Med 2022; 11:jcm11247468. [PMID: 36556084 PMCID: PMC9784170 DOI: 10.3390/jcm11247468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
The survival rate of preterm infants is increasing as a result of technological advances. The incidence of intraventricular hemorrhages (IVH) in preterm infants ranges from 25% to 30%, of which 30% to 50% are severe IVH (Volpe III-IV, Volpe III is defined as intraventricular bleeding occupying more than 50% of the ventricular width and acute lateral ventricle dilatation, Volpe IV is defined as intraventricular hemorrhage combined with venous infarction) and probably lead to posthemorrhagic ventricular dilatation (PHVD). Severe IVH and subsequent PHVD have become the leading causes of brain injury and neurodevelopmental dysplasia in preterm infants. This review aims to review the literature on the diagnosis and therapeutic strategies for PHVD and provide some recommendations for management to improve the neurological outcomes.
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Affiliation(s)
- Gengying Liu
- Neonatology Department, Guangdong Women and Children Hospital, Guangzhou 510010, China
- Guangdong Neonatal ICU Medical Quality Control Center, Guangzhou 510010, China
| | - Chuan Nie
- Neonatology Department, Guangdong Women and Children Hospital, Guangzhou 510010, China
- Guangdong Neonatal ICU Medical Quality Control Center, Guangzhou 510010, China
- Correspondence:
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Lai GY, Shlobin N, Garcia RM, Wescott A, Kulkarni AV, Drake J, Dizon ML, Lam SK. Global incidence proportion of intraventricular haemorrhage of prematurity: a meta-analysis of studies published 2010-2020. Arch Dis Child Fetal Neonatal Ed 2022; 107:513-519. [PMID: 34930831 DOI: 10.1136/archdischild-2021-322634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/25/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate differences and calculate pooled incidence of any intraventricular haemorrhage (IVH), severe IVH (Grade III/IV, sIVH) and ventriculoperitoneal shunt (VPS) placement in preterm infants across geographical, health and economic regions stratified by gestational age (GA). DESIGN MEDLINE, Embase, CINAHL and Web of Science were searched between 2010 and 2020. Studies reporting rates of preterm infants with any IVH, sIVH and VPS by GA subgroup were included. Meta-regression was performed to determine subgroup differences between study designs and across United Nations geographical regions, WHO mortality strata and World Bank lending regions. Incidence of any IVH, sIVH and VPS by GA subgroups<25, <28, 28-31, 32-33 and 34-36 weeks were calculated using random-effects meta-analysis. RESULTS Of 6273 publications, 97 met inclusion criteria. Incidence of any IVH (37 studies 87 993 patients) was: 44.7% (95% CI 40.9% to 48.5%) for GA <25 weeks, 34.3% (95% CI 31.2% to 37.6%) for GA <28 weeks, 17.4% (95% CI 13.8% to 21.6%) for GA 28-31 weeks, 11.3% (95% CI 7.3% to 17.0%) for GA32-33 weeks and 4.9% (95% CI 1.4% to 15.2%) for GA 34-36 weeks. Incidence of sIVH (49 studies 328 562 patients) was 23.7% (95% CI 20.9% to 26.7%) for GA <25 weeks, 15.0% (95% CI 13.1% to 17.2%) for GA <28 weeks, 4.6% (95% CI 3.5% to 6.1%) for GA 28-31 weeks, 3.3% (95% CI 2.1% to 5.1%) for GA 32-33 weeks and 1.8% (95% CI 1.2% to 2.8%) for GA 34-36 weeks. Europe had lower reported incidence of any IVH and sIVH relative to North America (p<0.05). Proportion of VPS across all GA groups was 8.4% (95% CI 4.7% to 14.7%) for any IVH and 17.2% (95% CI 12.2% to 26.2%) for sIVH. Heterogeneity was high (I2 >90%) but 64%-85% of the variance was explained by GA and study inclusion criteria. CONCLUSIONS We report the first pooled estimates of IVH of prematurity by GA subgroup. There was high heterogeneity across studies suggesting a need for standardised incidence reporting guidelines.
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Affiliation(s)
- Grace Y Lai
- Neurological Surgery, McGaw Medical Center of Northwestern University, Chicago, Illinois, USA
| | - Nathan Shlobin
- Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Roxanna M Garcia
- Neurological Surgery, McGaw Medical Center of Northwestern University, Chicago, Illinois, USA
| | - Annie Wescott
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Abhaya V Kulkarni
- University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James Drake
- University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maria Lv Dizon
- Neonatology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Sandi K Lam
- Neurological Surgery, McGaw Medical Center of Northwestern University, Chicago, Illinois, USA.,Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Cheng YK, Liu CL. Antibiotic-impregnated external ventricular drainage for the management of post-hemorrhagic hydrocephalus in low birth weight premature infants following intraventricular hemorrhage. Childs Nerv Syst 2022; 38:1567-1572. [PMID: 35513728 DOI: 10.1007/s00381-022-05542-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/22/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aims to evaluate the infection rates and catheterization duration of applying antibiotic-impregnated external ventricular drain (EVD) for the treatment of post-hemorrhagic hydrocephalus (PHH) in low birth weight infants (LBWI). METHODS This retrospective cohort study included 13 preterm LBWI with PHH. Data were collected from the patient's medical charts and included gender, gestational age, birth weight, intraventricular hemorrhage grade, ventriculostomy-associated infection (VAI), and the duration of catheterization. All patients were followed up for at least 6 months after EVD surgery. RESULTS The mean gestational age at birth was 27 ± 2.5 weeks, and the mean birth weight was 907 ± 220 g. Among all patients with IVH, two (6.7%) had grade 2 IVH, five (38.5%) had grade 3 IVH, and six (46.2%) had grade 4 IVH. EVD surgery was conducted once for six patients, twice for five patients, and three times for two patients. One patient (7.7%) had VAI post-EVD surgery at 14 days. Three patients (23%) expired due to sepsis, shock, and chylous ascites. Seven patients (53.8%) had hydrocephalus and needed a ventriculoperitoneal shunt over the following course. The longest EVD catheterization period was 57 days without sustained VAI. CONCLUSIONS Antibiotic-impregnated EVD has a similar infection rate with the ventricular access device and ventriculosubgaleal shunt. The risk of VAI was not increased even with the EVD catheterization day approaching 2 months. Our study supports the evidence that antibiotic-impregnated EVD is safe and effective for the management of PHH in LBWI. However, this research has a small sample sized and a retrospective design.
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Affiliation(s)
- Yu-Kai Cheng
- Department of Neurosurgery, China Medical University Hospital, North District, No.2, Yude Road, Taichung City, 404472, Taiwan, Republic of China.,China Medical University, Taichung City, Taiwan, Republic of China.,China Medical University Children's Hospital, Taichung City, Taiwan, Republic of China
| | - Chin-Lin Liu
- Department of Neurosurgery, China Medical University Hospital, North District, No.2, Yude Road, Taichung City, 404472, Taiwan, Republic of China. .,China Medical University, Taichung City, Taiwan, Republic of China.
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Preterm-related posthemorrhagic hydrocephalus: Review of our institutional series with a long-term follow-up. Neurocirugia (Astur) 2022. [DOI: 10.1016/j.neucir.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Modelling success after perinatal post-haemorrhagic hydrocephalus: a single-centre study. Childs Nerv Syst 2022; 38:1903-1906. [PMID: 35796861 PMCID: PMC9522750 DOI: 10.1007/s00381-022-05597-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Post-haemorrhagic hydrocephalus is common amongst premature infants and one of the leading indications for paediatric cerebrospinal fluid (CSF) diversion. Permanent CSF diversion is often delayed until the infant is older but there is no clear consensus on the timing for this. The outcomes for permanent shunting in this patient group are poor, with higher rates of failure and infection compared to other aetiologies of hydrocephalus. METHODS We conduct a single-centre retrospective review of infants with post-haemorrhagic hydrocephalus requiring a permanent shunt insertion over a 5-year period. Demographic and clinical data from time of shunt insertion were collected and used to generate generalised linear models (GLMs) to predict shunt success at 12 months after insertion. RESULTS Twenty-six infants underwent permanent shunting in this period for post-haemorrhagic hydrocephalus, with 10 suffering shunt failure within the first 12 months. The best-performing GLM was able to predict shunt success with a sensitivity of 1 and specificity of 0.90, with head circumference, weight, and corrected age at the time of shunt insertion being the most significantly associated variables for shunt success in this model. CONCLUSION Our proof-of-principle study suggests that highly accurate prediction of shunt success for infants with post-haemorrhagic hydrocephalus is possible using routinely available clinical variables. Further work is required to test this model in larger cohorts and validate whether pre-operative use can improve outcomes for this patient group.
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Liu YF, Huang CL, Tong XM, Zhang Y, Zeng L, Yuan JF. Effect of surgical treatment on prognosis in preterm infants with obstructive hydrocephalus. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:1214-1220. [PMID: 34911603 PMCID: PMC8690706 DOI: 10.7499/j.issn.1008-8830.2108119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To study the effect of surgical treatment on prognosis in preterm infants with obstructive hydrocephalus. METHODS A retrospective analysis was performed on the medical data of 49 preterm infants with obstructive hydrocephalus. According to the treatment regimen, they were divided into two groups: surgical treatment (n=12) and conservative treatment (n=37). The drainage methods, drainage complications, and eventual shunt outcome were analyzed in the surgical treatment group. The two groups were compared in terms of the etiology of hydrocephalus and prognosis. RESULTS Among the 49 preterm infants with obstructive hydrocephalus, severe intracranial hemorrhage (37 cases; 76%) and central nervous system infection (10 cases, 20%) were the main causes of hydrocephalus. There was no significant difference in the composition of etiology between the two groups (P>0.05). In the surgical treatment group, 4 infants were treated with ventriculosubgaleal shunt and 8 were treated with Ommaya reservoir. One infant had secondary infection and 8 infants eventually underwent ventriculoperitoneal shunt. The surgical treatment group had a significantly higher survival rate than the conservative treatment group (P<0.05). As for the 37 preterm infants with severe intracranial hemorrhage, the surgical treatment group had a significantly higher proportion of infants with normal neurodevelopment than the conservative treatment group (P<0.05). As for the 10 preterm infants with central nervous system infection, neurodevelopmental abnormalities were observed in each of the two groups. CONCLUSIONS Surgical treatment can improve the survival rate of preterm infants with obstructive hydrocephalus and the prognosis of preterm infants with severe intracranial hemorrhage.
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Affiliation(s)
- Yun-Feng Liu
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
| | - Chun-Ling Huang
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
| | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
| | | | | | - Jin-Fang Yuan
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
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11
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Lai GY, Chu-Kwan W, Westcott AB, Kulkarni AV, Drake JM, Lam SK. Timing of Temporizing Neurosurgical Treatment in Relation to Shunting and Neurodevelopmental Outcomes in Posthemorrhagic Ventricular Dilatation of Prematurity: A Meta-analysis. J Pediatr 2021; 234:54-64.e20. [PMID: 33484696 DOI: 10.1016/j.jpeds.2021.01.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/11/2020] [Accepted: 01/14/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the relationship between timing of initiation of temporizing neurosurgical treatment and rates of ventriculoperitoneal shunt (VPS) and neurodevelopmental impairment in premature infants with post-hemorrhagic ventricular dilatation (PHVD). STUDY DESIGN We searched MEDLINE, EMBASE, CINAHL, Web of Science, the Cochrane Database of Systematic Reviews, and the Cochrane Center Register of Controlled Trials for studies that reported on premature infants with PHVD who underwent a temporizing neurosurgical procedure. The timing of the temporizing neurosurgical procedure, gestational age, birth weight, outcomes of conversion to VPS, moderate-to-severe neurodevelopmental impairment, infection, temporizing neurosurgical procedure revision, and death at discharge were extracted. RESULTS Sixty-two full-length articles and 6 conference abstracts (n = 2533 patients) published through November 2020 were included. Pooled rate for conversion to VPS was 60.5% (95% CI, 54.9-65.8), moderate-severe neurodevelopmental impairment 34.8% (95% CI, 27.4-42.9), infection 8.2% (95% CI, 6.7-10.1), revision 14.6% (95% CI, 10.4-20.1), and death 12.9% (95% CI, 10.2-16.4). The average age at temporizing neurosurgical procedure was 24.2 ± 11.3 days. On meta-regression, older age at temporizing neurosurgical procedure was a predictor of conversion to VPS (P < .001) and neurodevelopmental impairment (P < .01). Later year of publication predicted increased survival (P < .01) and external ventricular drains were associated with more revisions (P = .001). Tests for heterogeneity reached significance for all outcomes and a qualitative review showed heterogeneity in the study inclusion and diagnosis criteria for PHVD and initiation of temporizing neurosurgical procedure. CONCLUSIONS Later timing of temporizing neurosurgical procedure predicted higher rates of conversion to VPS and moderate-severe neurodevelopmental impairment. Outcomes were often reported relative to the number of patients who underwent a temporizing neurosurgical procedure and the criteria for study inclusion and the initiation of temporizing neurosurgical procedure varied across institutions. There is need for more comprehensive outcome reporting that includes all infants with PHVD regardless of treatment.
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Affiliation(s)
- Grace Y Lai
- Department of Neurological Surgery, McGaw Medical Center of Northwestern University, Chicago, IL; Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - William Chu-Kwan
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Departments of Surgery and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Annie B Westcott
- Galter Health Science Library, Northwestern University, Chicago, IL
| | - Abhaya V Kulkarni
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Departments of Surgery and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - James M Drake
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Departments of Surgery and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Sandi K Lam
- Department of Neurological Surgery, McGaw Medical Center of Northwestern University, Chicago, IL; Division of Neurosurgery, Ann & Robert Lurie Children's Hospital, Chicago, IL
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12
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Sil K, Ghosh SK, Chatterjee S. Ventriculo-subgaleal shunts-broadening the horizons: an institutional experience. Childs Nerv Syst 2021; 37:1113-1119. [PMID: 33188445 DOI: 10.1007/s00381-020-04929-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/12/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Ventriculo-subgaleal shunt is an established treatment of hydrocephalus following germinal matrix haemorrhage in low birth weight neonates. It is also used in treatment of post-infective hydrocephalus in children. We intend to emphasise the impact of its extended use in multiple clinical conditions to reduce the number of permanent shunt implantation in infants. METHOD Retrospective review of clinical cases in a single institution from medical records. RESULTS VSG shunts with low-pressure valve system were useful in variety of hydrocephalus in infants (post-haemorrhagic, post-infective, post-myelomeningocele, post-shunt block, post-traumatic, hydrocephalus associated with brain tumours). A significant number of infants especially those with post-haemorrhagic and post-myelomeningocele hydrocephalus could be made free of permanent shunt placement. CONCLUSIONS Ventriculo-subgaleal shunt is an effective, less risky temporary solution of hydrocephalus in infants and can be used in a variety of hydrocephalus in children and helps in avoiding shunt dependency in some of them.
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Affiliation(s)
- Kaushik Sil
- Park Neuroscience Service, Park Clinic, Kolkata, India
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13
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Chatterjee S. The Leftover Shunts - Ventriculosubgaleal, and Ventriculocholecystal Shunts. Neurol India 2021; 69:S488-S494. [DOI: 10.4103/0028-3886.332246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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14
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Chari A, Mallucci C, Whitelaw A, Aquilina K. Intraventricular haemorrhage and posthaemorrhagic ventricular dilatation: moving beyond CSF diversion. Childs Nerv Syst 2021; 37:3375-3383. [PMID: 33993367 PMCID: PMC8578081 DOI: 10.1007/s00381-021-05206-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022]
Abstract
Advances in medical care have led to more premature babies surviving the neonatal period. In these babies, germinal matrix haemorrhage (GMH), intraventricular haemorrhage (IVH) and posthaemorrhagic ventricular dilatation (PHVD) are the most important determinants of long-term cognitive and developmental outcomes. In this review, we discuss current neurosurgical management of IVH and PHVD, including the importance of early diagnosis of PHVD, thresholds for intervention, options for early management through the use of temporising measures and subsequent definitive CSF diversion. We also discuss treatment options for the evolving paradigm to manage intraventricular blood and its breakdown products. We review the evidence for techniques such as drainage, irrigation, fibrinolytic therapy (DRIFT) and neuroendoscopic lavage in the context of optimising cognitive, neurodevelopmental and quality of life outcomes in these premature infants.
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Affiliation(s)
- Aswin Chari
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK ,Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children’s Hospital, Liverpool, UK
| | - Andrew Whitelaw
- Neonatal Neuroscience, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK. .,Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK.
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15
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Palpan Flores A, Saceda Gutiérrez J, Brin Reyes JR, Sierra Tamayo J, Carceller Benito F. Risk factors associated with conversion of an Ommaya reservoir to a permanent cerebrospinal fluid shunt in preterm posthemorrhagic hydrocephalus. J Neurosurg Pediatr 2020; 25:417-424. [PMID: 31952037 DOI: 10.3171/2019.11.peds19320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/11/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A considerable percentage of preterm infants with posthemorrhagic hydrocephalus initially managed with an Ommaya reservoir require a permanent CSF shunt. The objective of the study was to analyze possible risk factors associated with the need for converting an Ommaya reservoir to a permanent shunt. METHODS The authors retrospectively reviewed the clinical records of premature infants weighing 1500 g or less with posthemorrhagic hydrocephalus (Papile grades III and IV) managed with an Ommaya reservoir at their institution between 2002 and 2017. RESULTS Forty-six patients received an Ommaya reservoir. Five patients (10.9%) were excluded due to intraventricular infection during management with an Ommaya reservoir. Average gestational age and weight for the remaining 41 patients was 27 ± 1.8 weeks and 987 ± 209 grams, respectively. Thirty patients required a permanent shunt and 11 patients did not require a permanent shunt. The conversion rate from an Ommaya reservoir to a permanent shunt was 76.1%. Symptomatic persistent ductus arteriosus (PDA) was more frequent in the nonpermanent shunt group than in the shunt group (88.9% vs 50%, p = 0.04). The need for extraction of more than 10 ml/kg per day of CSF through the Ommaya reservoir was lower in the nonpermanent shunt group than in the shunt group (9.1% vs 51.7%, p = 0.015). CSF lactate was lower in the nonpermanent group than in the shunt group (mean 2.48 mg/dl vs 3.19 mg/dl; p = 0.004). A cutoff value of ≥ 2.8 mg/dl CSF lactate predicted the need for a permanent shunt with sensitivity and specificity of 82.4% and 80%, respectively. There were no significant differences in gestational age, sex, weight, Papile grade, ventricular index, or other biochemical markers. After the multivariate analysis, only CSF lactate ≥ 2.8 mg/dl was associated with a higher conversion rate to a permanent shunt. CONCLUSIONS This study showed that a high level of CSF lactate, absence of symptomatic PDA, and a higher CSF extraction requirement were associated with a higher likelihood of implanting a permanent CSF shunt. The authors believe these findings should be considered in future studies.
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Affiliation(s)
- Alexis Palpan Flores
- 1Department of Pediatric Neurosurgery, La Paz University Hospital, Madrid, Spain
| | | | - Juan Raúl Brin Reyes
- 2Department of Pediatric Neurosurgery, Omar Torrijos Herrera Hospital, Panama City, Panama; and
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Polis B, Polis L, Zeman K, Paśnik J, Nowosławska E. Unexpected eosinophilia in children affected by hydrocephalus accompanied with shunt infection. Childs Nerv Syst 2018; 34:2399-2405. [PMID: 30032408 PMCID: PMC6224006 DOI: 10.1007/s00381-018-3908-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 07/06/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the article is to describe an immunological reaction to shunt infection in children with hydrocephalus. The main cause of shunt infection involves methicillin resistant Staphylococcus epidermidis (Bhatia et al. Indian J Med Microbiol 35:120-123, 2017; Hayhurst et al. Childs Nerv Syst 24:557-562, 2008; Martínez-Lage et al. Childs Nerv Syst 26: 1795-1798, 2010; Simon et al. PLoS One, 2014; Snowden et al. PLoS One 8:e84089, 2013; Turgut et al. Pediatr Neurosurg 41:131-136, 2005), a bacterial strain which is responsible for the formation of biofilm on contaminated catheters (Snowden et al. PLoS One 8:e84089, 2013; Stevens et al. Br J of Neurosurg 26: 792-797, 2012). METHODS The study group involved 30 children with congenital hydrocephalus after shunt system implantation, whose procedures were complicated by S. epidermidis implant infection. Thirty children with congenital hydrocephalus awaiting their first-time shunt implantation formed the control group. The level of eosinophils in peripheral blood was assessed in both groups. Cerebrospinal fluid (CSF) was examined for protein level, pleocytosis, interleukins, CCL26/Eotaxin-3, IL-5, IL-6, CCL11/Eotaxin-1, CCL3/MIP-1a, and MBP. Three measurements were performed in the study group. The first measurement was obtained at the time of shunt infection diagnosis, the second one at the time of the first sterile shunt, and the third one at the time of shunt reimplantation. In the control group, blood and CSF samples were taken once, at the time of shunt implantation. RESULTS In the clinical material, the highest values of eosinophils in peripheral blood and CSF pleocytosis were observed in the second measurement. It was accompanied by an increase in the majority of analyzed CSF interleukins. CONCLUSION CSF pleocytosis observed in the study group shortly after CSF sterilization is presumably related to an allergic reaction to Staphylococcus epidermidis, the causative agent of ventriculoperitoneal shunt infection.
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Affiliation(s)
- Bartosz Polis
- Department of Neurosurgery, Polish Mother’s Memorial Hospital Research Institute, Rzgowska st 281/289, 93-338 Łódź, Poland
| | - Lech Polis
- Department of Neurosurgery, Polish Mother’s Memorial Hospital Research Institute, Rzgowska st 281/289, 93-338 Łódź, Poland
| | - Krzysztof Zeman
- Department of Pediatrics and Immunology with Nephrology Unit, Polish Mother’s Memorial Hospital Research Institute, Rzgowska st 281/289, 93-338 Łódź, Poland
| | - Jarosław Paśnik
- Department of Pediatrics and Immunology with Nephrology Unit, Polish Mother’s Memorial Hospital Research Institute, Rzgowska st 281/289, 93-338 Łódź, Poland
| | - Emilia Nowosławska
- Department of Neurosurgery, Polish Mother's Memorial Hospital Research Institute, Rzgowska st 281/289, 93-338, Łódź, Poland.
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Kutty RK, Sreemathyamma SB, Korde P, Prabhakar RB, Peethambaran A, Libu GK. Outcome of Ventriculosubgaleal Shunt in the Management of Infectious and Non-infectious Hydrocephalus in Pre-term Infants. J Pediatr Neurosci 2018; 13:322-328. [PMID: 30271465 PMCID: PMC6144600 DOI: 10.4103/jpn.jpn_41_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Hydrocephalus in premature infants is an onerous disease. In such situations, choosing the best option for cerebrospinal fluid (CSF) diversion is difficult. Ventriculosubgaleal shunt is an effective method of temporary CSF diversion in such situations. In this retrospective study, we compare the outcome of ventriculosubgaleal shunt in premature infants with hydrocephalus of infectious and noninfectious etiology. Materials and Methods: All premature children with hydrocephalus secondary to various etiologies who underwent ventriculosubgaleal shunt were studied. The participants were grouped into two depending upon the etiology of hydrocephalus: Group 1 (infectious) and Group 2 (non-infectious). The primary outcome was a successful conversion to ventriculoperitoneal shunt (VPS) and the secondary outcome was mortality. Data were entered into statistical software SPSS version 16 and appropriate statistical analysis was performed to conclude any statistical significance between groups. Results: The study included 16 infants among whom 9 were in the infectious group and 7 in the non-infectious group. Primary end point of conversion to VPS was achieved in 55.5% of patients in group 1 and 85.7% in group 2. The secondary end point, i.e., mortality was observed in 44.4% of patients in group 1 and 14.2% in group 2. The average duration during which this was achieved was 40 days (range 20–60 days) in group 1 and 25 days (range 20–30 days) in group 2. Conclusion: Ventriculosubgaleal shunt is a safe and effective procedure in infants awaiting definitive VPS for hydrocephalus of infectious as well as noninfectious origin. There was no statistical difference in the rate of successful conversion to a permanent VPS from ventriculosubgaleal shunt in hydrocephalus of either etiologies. Complications and time for successful conversion were more in postmeningitic hydrocephalus.
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Affiliation(s)
- Raja K Kutty
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | | | - Paresh Korde
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Rajmohan B Prabhakar
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Anilkumar Peethambaran
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Gnanaseelan K Libu
- Department of Preventive Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
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Kern M, Carlson NS. Current Resources for Evidence-Based Practice, March/April 2017. J Obstet Gynecol Neonatal Nurs 2017; 46:e27-e36. [PMID: 28141995 DOI: 10.1016/j.jogn.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Kumar N, Al-Faiadh W, Tailor J, Mallucci C, Chandler C, Bassi S, Pettorini B, Zebian B. Neonatal post-haemorrhagic hydrocephalus in the UK: a survey of current practice. Br J Neurosurg 2016; 31:307-311. [PMID: 27687144 DOI: 10.1080/02688697.2016.1226260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Naveen Kumar
- Faculty of Medicine, King’s College London, London, UK
| | | | - Jignesh Tailor
- Department of Neurosurgery, King’s College Hospital, Denmark Hill, London, UK
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children’s Hospital, Eaton Road, West Derby, Liverpool, UK
| | - Chris Chandler
- Department of Neurosurgery, King’s College Hospital, Denmark Hill, London, UK
| | - Sanj Bassi
- Department of Neurosurgery, King’s College Hospital, Denmark Hill, London, UK
| | - Benedetta Pettorini
- Department of Neurosurgery, Alder Hey Children’s Hospital, Eaton Road, West Derby, Liverpool, UK
| | - Bassel Zebian
- Department of Neurosurgery, King’s College Hospital, Denmark Hill, London, UK
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