gms | German Medical Science

Objective: Despite the improvements in preventing intraventricular haemorrhage in preterm babys, the management of the post-haemorrhagic hydrocephalus, one of the most common consequences, is still a challenge for the neurosurgeon. In very-low-birth-weight infants, the placement of a ventriculoperitoneal shunt cannot be carried out immediately and different medical and surgical temporary measures have been used in these neonates. We report our experience in a premature patient with post-haemorrhagic hydrocephalus, who was treated before the placement of a ventriculoperitoneal shunt, with selective ventricular tapping and irrigation via a closed system after the placement of a ventricular access device.

Methods: This is a case of a low-birth-weight infant (1,230 g) born in the 30^th week of gestation with a Papile scale grade IV haemorrhage, increased head circumference and a bulging fontanel. After placement of the ventricular access device the CSF samples yielded erythrocytes in uncountable numbers. Before the placement of a ventriculoperitoneal shunt, the patient was treated with selective ventricular tapping and irrigation via a closed system connected to the ventricular access device.

Results: Via this closed system 5x 50 ml of CSF were aspirated every second day. After each aspiration 5x 50 ml of NaCl 0,9% were injected at a temperature of 37°C. The protein and cell number of the withdrawn fluid reached the normal levels after ten days. After this time the patient was able to be successfully shunted with an adjustable valve and developed no postoperative shuntdysfunction.

Conclusions: The presented aspiration and irrigation system can be a successful therapeutic alternative for selected patients with a massively haemorrhagic CSF.