Subcutaneous Ventricular Catheter Reservoir Research Articles

Surgical management of hydrocephalus secondary to intraventricular hemorrhage in the preterm infant.

OBJECT Posthemorrhagic hydrocephalus (PHH) in the preterm infant remains a major neurological complication of prematurity. The authors first described insertion of a specially designed low-profile subcutaneous ventricular catheter reservoir for temporary management of hydrocephalus in 1983. This report presents the follow-up experience with the surgical management of PHH in this population and describes outcomes both in infants who were stable for permanent shunt insertion and those initially temporized with a ventricular reservoir (VR) prior to permanent ventriculoperitoneal (VP)/ventriculoatrial (VA) shunt placement. METHODS A retrospective review was undertaken of the medical records of all premature infants surgically treated for posthemorrhagic hydrocephalus (PHH) between 1997 and 2012 at Children's Hospital Los Angeles. RESULTS Over 14 years, 91 preterm infants with PHH were identified. Fifty neonates received temporizing measures via a VR that was serially tapped for varying time periods. For the remaining 41 premature infants, VP/VA shunt placement was the first procedure. Patients with a temporizing measure as their initial procedure had undergone CSF diversion significantly earlier in life than those who had permanent shunting as the initial procedure (29 vs 56 days after birth, p < 0.01). Of the infants with a VR as their initial procedure, 5/50 (10%) did not undergo subsequent VP/VA shunt placement. The number of shunt revisions and the rates of loculated hydrocephalus and shunt infection did not statistically differ between the 2 groups. CONCLUSIONS Patients with initial VR insertion as a temporizing measure received a CSF diversion procedure significantly earlier than those who received a permanent shunt as their initial procedure. Otherwise, the outcomes with regard to shunt revisions, loculated hydrocephalus, and shunt infection were not different for the 2 groups.

Cerebral hemodynamics and oxygenation after serial CSF drainage in infants with PHVD

The aim of our study was to assess consecutive changes in cerebral oxygenation and hemodynamics after serial cerebrospinal fluid (CSF) drainage from a subcutaneous ventricular catheter reservoir (SVCR) in infants with PHVD. Infants with PHVD were studied during CSF drainage from a SVCR on the day of SVCR placement, half a week and one week after SVCR placement. Changes in cHbD and CBV were assessed using near infrared spectrophotometry. Time averaged peak flow velocity (TAPFV), end diastolic flow velocity (EDFV), peak systolic flow velocity (PSFV) and pulsatility index (PI) were measured before (baseline) and after CSF drainage using Doppler ultrasound. Longitudinal data analysis was performed using linear mixed models. Seven patients (GA 26.7–40.4 weeks, BW 800–4575 g) were studied. CSF drainage resulted in a statistically significant increase in CBV during each measurement. The change in CBV was maximal on the day of SVCR placement. A significant increase in cHbD and EDFV, and decrease in PI was observed after CSF drainage only on the day of SVCR placement. Baseline values of all Doppler variables improved consecutively after serial CSF removal in the first week after SVCR placement. Frequent CSF drainage results in consecutive improvement of cerebral perfusion and oxygenation in infants with PHVD.

Cerebral blood flow velocity before and after cerebrospinal fluid drainage in infants with posthemorrhagic hydrocephalus.

Currently, the timing and volume of cerebrospinal fluid (CSF) drainage are determined by subjective clinical findings in infants with posthemorrhagic hydrocephalus. The aim of this study was to determine whether measurement of the resistive index is useful for management of CSF drainage in these infants. We measured the resistive index in the anterior cerebral artery (RI-ACA) by using pulsed Doppler sonography before and after lumbar or subcutaneous ventricular catheter reservoir punctures in 7 infants with posthemorrhagic hydrocephalus. The increased RI-ACA values (mean +/- SD, 0.86 +/- 0.04; range, 0.80-0.89) decreased significantly (0.76 +/- 0.05; 0.64-0.83) after removal of CSF at a rate of 5 to 10 mL/kg (P <.0001). We suggest that measurement of the RI-ACA may be useful for evaluating the efficacy of CSF drainage and to determine how much CSF should be removed in hydrocephalic infants.

259 Cerebral Hemodynamics and Oxygenation after Removal of Cerebral Spinal Fluid from A Subcutaneous Ventricular Catheter Reservoir in Infants with a Post Hemorrhagic Ventricular Dilatation

Background: Removal of cerebral spinal fluid (CSF) is the common treatment of post hemorrhagic ventricular dilatation (PHVD) in newborn infants. Puncture from a subcutaneous ventricular catheter reservoir (SVCR) allows easy CSF removal with minimal discomfort for the patient.Aims: To assess changes in cerebral oxygenation and hemodynamics after serial CSF removal from a SVCR in infants with PHVD.Methods: 6 infants (GA 216–258 days, BW 1490–2901 gram) were included for this study. These patients were studied during CSF drainage at day 1, 3 and 7 after SVCR placement. The amount of CSF removal was 5.5–9.6 ml/kg. Changes in concentration of oxyhemoglobin (ÄcO2Hb) and deoxyhemoglobin (ÄcHHb) were continuously measured using near infrared spectrophotometry. The difference in ÄcO2Hb and ÄcHHb, indicated as ÄcHbD, represents changes in cerebral blood oxygenation. Concentration changes in total hemoglobin (ÄctHb), calculated as the sum of ÄcO2Hb and ÄcHHb, reflects changes in cerebral blood volume. Changes in cHbD and ctHb were calculated between t=0 (start of CSF removal) and at 15, 30 and 60 minutes after CSF removal. Changes in mean cerebral blood flow velocity (ÄCBFV) in the internal carotid artery were intermittently measured using Doppler ultrasound. Physiologic variables (heart rate, arterial oxygen saturation, respiration rate and arterial blood pressure) were recorded. Results: Values are median (interquartile range). * significant changes (p <0.05, Wilcoxon-signed ranks test). There were no significant changes in physiological parameters.Conclusion: CSF removal from a SVCR results in improvement of cerebral perfusion, particularly the first day after SVCR placement. Cerebral blood oxygenation is only significantly increased at the day of SVCR placement. These changes are probably related to a reduction in intracranial pressure.

Intracranial pressure and cerebral blood flow velocity in preterm infants with posthaemorrhagic ventricular dilatation

Aim: To determine the volume of cerebrospinal fluid (CSF) that should be tapped in preterm infants with posthaemorrhagic ventricular dilatation as guided by intracranial pressure (ICP) and cerebral blood flow...

Subcutaneous ventricular catheter reservoir and ventriculoperitoneal drain-related infections in preterm infants and young children

In the period January 1990 to September 1997, 70 patients, aged under 6 years were treated for hydrocephalus with a subcutaneous ventricular catheter reservoir and/or a ventriculoperitoneal drain at the University Hospital of Maastricht. By means of a retrospective chart analysis, the number of shunt infections and related risk factors were analyzed. Twenty-one patients (30%) developed one or more infections, with an infection rate of 15.2% per surgical event. For an implanted reservoir or drain, the infection rates were 15.9 and 16.4%, respectively. The study group consisted of 39 (55.7%) preterm infants (< 37 weeks) and 31 (44.3%) full-term infants (> or = 37 weeks), with infection rates of 33.3 and 25.8%, respectively. At the first surgical intervention 28 patients (40%) had a postmenstrual age less than 37 weeks, with an infection rate of 46.4%. At the time of surgery, 69.7% of the patients were aged less than 6 months, with an infection rate of 19.6%. The most frequent causative microorganism of the shunt infections was Staphylococcus epidermidis (42.1%). Prematurity is an important risk factor for ventricular catheter reservoir and ventriculoperitoneal drain-related infections, especially for patients with a postmenstrual age of less than 37 weeks at their initial shunt placement and extreme low birth weight infants have a high risk for infection. In our opinion the use of adequate antibiotic prophylaxis and optimal infection control measures are necessary to keep the rate of infection as low as possible.

Morbidity and Neurodevelopmental Outcome in Preterm Infants after Posthemorrhagic Hydrocephalus Treated with a Subcutaneous Ventricular Catheter Reservoir

Morbidity and Neurodevelopmental Outcome in Preterm Infants after Posthemorrhagic Hydrocephalus Treated with a Subcutaneous Ventricular Catheter Reservoir

Use of neonatal intensive care unit as a safe place for neonatal surgery

AIMTo evaluate the advantages, disadvantages, and short term morbidity and mortality of major surgical interventions performed in the neonatal intensive care unit.METHODSA retrospective case review of 45 neonates was performed...

Management of Hydrocephalus with IC Pressure Monitor

Thirteen premature infants with posthemorrhagic hydrocephalus were treated by repeated aspiration of cerebrospinal fluid using a subcutaneous ventricular catheter reservoir at the Departments of Paediatrics and Neurosurgery, University of Heidelberg, Federal Republic of Germany.

Management of posthaemorrhagic hydrocephalus with a subcutaneous ventricular catheter reservoir in premature infants.

A subcutaneous ventricular catheter reservoir was inserted between the 16th and 28th (median 23rd) day of life in 13 premature infants (median birth weight 1220 g, range 780-2110) for the treatment of posthaemorrhagic hydrocephalus. Aspiration of cerebrospinal fluid (median 6 ml, range 1-15) one to four (median two) times a day for 6 to 90 (median 40) days controlled the hydrocephalus as judged by clinical and ultrasonographic criteria. There were no serious complications, except skin breakdown in one patient. Intracranial pressure measured in five patients through the reservoir showed the efficacy of the treatment, as well as the unreliability of clinical and ultrasonographic criteria in determining the amount of cerebrospinal fluid that should be aspirated daily.

Management of obstructive hydrocephalus secondary to posterior fossa tumors by steroids and subcutaneous ventricular catheter reservoir.

In 61 patients (38 adults and 23 children) with surgically treatable tumors of the posterior fossa and obstructive hydrocephalus the following treatment for hydrocephalus was employed: a high dose of steroids was given after diagnosis; a frontal ventricular catheter with a subcutaneous fluid reservoir (Rickham) was inserted within 2 to 5 days; a temporary external ventricular drainage system was attached to the reservoir if, despite the steroids, intracranial pressure was over 30 cm H2O; and tumor excision was performed within 5 days to reopen the cerebrospinal fluid (CSF) pathways. In view of the wide range of potential complications, it was decided not to use a shunt before craniotomy. A shunt was inserted only if the CSF pathways remained obstructed after tumor removal. With this regimen, 93% of all patients (100% of the adults and 83% of the children) were shunt-free after the operation, without fatal complications. The infection rate was 4.9%. It was concluded that the severity of symptoms of raised intracranial pressure from hydrocephalus, the intraventricular pressure, and the size or location of the tumor prior to surgery do not have prognostic value as to which patients will require a shunt after surgery.

Management of posthemorrhagic hydrocephalus in the preterm infant

We studied the use of a subcutaneous ventricular catheter reservoir in 19 preterm infants with birth posthemorrhagic hydrocephalus. These infants were a poor risk for insertion of ventriculoperitoneal shunt due to their small size and hemorrhagic ventricular fluid at the time of diagnosis. The age at reservoir insertion was 29 +/- 9 days and the weight was 1,217 +/- 414 g. The reservoir was kept in place for 51 +/- 29 days with the removal of 527 +/- 421 mL of fluid by 57 +/- 42 taps. All infants tolerated the procedure well. Only two infants developed infection despite multiple reservoir taps. One infant expired due to unrelated causes. Three infants did not require a permanent shunt, while 15 infants had a ventriculoperitoneal shunt inserted prior to discharge at 3 to 4 months of age. We conclude that ventricular catheter reservoir is a safe and effective palliative procedure in the management of post hemorrhagic hydrocephalus in small preterm infants.

Management of hydrocephalus secondary to intraventricular hemorrhage in the preterm infant with a subcutaneous ventricular catheter reservoir

Management of hydrocephalus secondary to intraventricular hemorrhage in the preterm infant with a subcutaneous ventricular catheter reservoir

Management of hydrocephalus secondary to intraventricular hemorrhage in the preterm infant with a subcutaneous ventricular catheter reservoir.

To control hydrocephalus resulting from massive intraventricular hemorrhage in premature neonates with respiratory distress syndrome, we inserted a specially designed low profile subcutaneous ventricular catheter reservoir (reservoir) by the 12th day of life (average; range, 3 to 30 days) in 20 neonates whose mean birth weight was 1110 +/- 270 g (28.7 +/- 1.6 weeks of gestation). The reservoir was repeatedly aspirated over 10 to 48 days. No cerebrospinal fluid infection, reservoir obstruction, or breakdown of the skin overlying the reservoir occurred. Serial computed tomographic scans documented control of the hydrocephalus and an increase in the thickness of the cortical mantle of the survivors. No mortality was associated with placement of the reservoir or its subsequent conversion, if necessary, to a ventriculoperitoneal shunt. However, only 7 of the 20 infants survived. On follow-up 3 to 5 years later, 2 of the 7 have normal intellectual and motor development. Two infants are normal intellectually, but have a motor deficit. The remaining 3 patients have both significant intellectual and motor developmental delay. The use of the reservoir is offered as a safe and effective alternative to repeated ventricular punctures, external ventricular drainage, or initial shunting. Aggressive management of hydrocephalus secondary to intraventricular hemorrhage may improve neurological function in some surviving neonates.