Artikel
Implantation of subcutaneous CSF reservoirs as primary treatment option for hydrocephalus in premature infants
Subkutanes Liquorreservoir zur primären Behandlung des posthämorrhagischen Hydrozephalus bei Frühgeburtlichkeit
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Veröffentlicht: | 8. Mai 2006 |
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Objective: There are different treatment modalities for hydrocephalus in infants with low birth weight, who do not qualify for primary shunt placement (EVD, subgaleal shunt, serial fontanel or lumbar punctures). The objective of our study was to determine the efficiency of subcutaneous CSF reservoirs as primary treatment for hydrocephalus in premature infants.
Methods: We retrospectively analyzed indication, clinical course and complications of 25 patients who were treated by implantation of a subcutaneous CSF reservoir within a 6-year-period. The follow-up period lasted until the day of shunt implantation or at least 1 year.
Results: 25 ventricular reservoirs were implanted in premature infants (8 female, 17 male). The mean age at the time of gestation was 28 weeks (24-36 weeks). Mean age at time of surgery was 40 days post partum (). Indication for surgery was posthemorrhagic hydrocephalus following IVH (n=21), meningitis (n=1), hydrocephalus associated with MMC (n=1), obstructive hydrocephalus associated with complex brain malformation (n=2). 19 of those reservoirs were subsequently converted to ventriculoperitoneal shunts after a mean time of 47 days (). Complications included 1 CSF re-infection in the patient who was previously treated for meningitis and 1 skin defect. CSF aspiration via reservoir was performed once or twice daily. During the period between implantation of the reservoir and shunt placement, patients were treated at their primary care facilities (Department of Paediatrics University Hospital or Community Hospital).
Conclusions: We conclude that the placement of subcutaneous CSF reservoirs for serial punctures is an effective method for the primary treatment for hydrocephalus in premature infants. The complication rate is low. For social and economic benefits, transient treatment at outside primary care facilities is possible.