1043-3155 Pediatr Neurol Briefs pedneurbriefs Pediatr Neurol Briefs Pediatric Neurology Briefs Pediatr Neurol Briefs 2166-6482 1043-3155 2166-3155 Pediatric Neurology Briefs Publishers Chicago, IL, USA PNB-6-67 10.15844/pedneurbriefs-6-9-3 Vascular Disorders Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant Post-Haemorrhagic Hydrocephalus: Outcome of Shunting http://orcid.org/0000-0002-0173-7931 Millichap J. Gordon MD 1 2 * Division of Neurology, Children's Memorial Hospital, Chicago, IL Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Correspondence: Dr. J. Gordon Millichap, E-mail: jgmillichap@northwestern.edu 09 1992 01 07 2016 6 9 67 68 Copyright: © 1992 The Author(s) 1992 This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Neurological outcome following neonatal post-haemorrhagic hydrocephalus: the effects of maximum raised intracranial pressure and ventriculo-peritoneal shunting

The neuromotor outcome of 33 survivors of grade 3 or 4 neonatal post-haemorrhagic hydrocephalus assessed at a mean age of 4.7 years is reported from the Department of Paediatric Neurology, The Royal Hospital for Sick Children, Edinburgh and the Western General Hospital, Edinburgh.

 Post-Haemorrhagic Hydrocephalus Parenchymal Cerebral Blood Flow

The neuromotor outcome of 33 survivors of grade 3 or 4 neonatal post-haemorrhagic hydrocephalus assessed at a mean age of 4.7 years is reported from the Department of Paediatric Neurology, The Royal Hospital for Sick Children, Edinburgh and the Western General Hospital, Edinburgh. Two-thirds of the children were moderately or severely impaired. Raised intracranial pressure was not significantly different between outcome groups. Of 27 shunted, those with 5 or more operations (10 children) had abnormal neurological outcomes. The rise in morbidity after the 4th shunt was associated with ventriculitis. Outcome was unrelated to the grade of intraventricular hemorrhage or parenchymal changes on ultrasound or CT scanning and was independent of antenatal and perinatal factors. [1]

COMMENT. This study shows that a rise in intracranial pressure in the acute stage of hydrocephalus does not carry a significant risk of further handicap or visual impairment. An adverse outcome was statistically related to more than 4 shunt procedures and ventriculitis. The authors’ criteria for VP shunting were: 1) increasing ventriculomegaly, 2) raised ICP on monitoring, including during sleep, and 3) abnormal cerebral perfusion as shown by repeated Doppler ultrasonography studies of cerebral blood flow velocity.

The surgical management of post-haemorrhagic hydrocephalus is reported in 22 low birth weight infants from the Department of Neurosurgery, Eastern Virginia Medical School, Norfolk, VA [2]. The use of subcutaneous ventricular reservoirs and a low pressure neonatal shunt was associated with a significant reduction in the morbidity and mortality compared to the use of external ventricular drainage devices.

The use of SPECT for the measurement of cerebral blood flow changes in 4 children with hydrocephalus is reported from the Departments of Neurosurgery and Radiology, Tokai University School of Medicine, Bohsei-dai, Isehara, Kanagawa, Japan [3]. A positive reabsorption ratio of radioactivity counted in early and delayed images was correlated with a favorable outcome in 3 patients.

An overview of the surgery of hydrocephalus: past, present and future, by Hirsch JF, Hopital Necker Enfants Malades, Paris, France is published [4]. The need for research in the causes and prevention of hydrocephalus is stressed.

 Lin JP Goh W Brown JK Steers AJ Neurological outcome following neonatal post-haemorrhagic hydrocephalus: the effects of maximum raised intracranial pressure and ventriculo-peritoneal shunting Child’s Nerv Syst 1992 Jun 8 4 190 197 10.1007/BF00262843 1394249 Gurtner P Bass T Gudeman SK Penix JO Philput CB Schinco FP Surgical management of posthemorrhagic hydrocephalus in 22 low-birth-weight infants Child’s Nerv Syst 1992 Jun 8 4 198 202 10.1007/BF00262844 1394250 Shinoda M Yamaguchi T Tanaka Y Sato O Kobayashi S Suzuki Y Single photon emission computerized tomography in childhood hydrocephalus Child’s Nerv Syst 1992 Jun 8 4 219 221 10.1007/BF00262851 1394255 Hirsch JF Surgery of hydrocephalus: past, present and future Acta Neurochir (Wien) 1992 116 2-4 155 160 10.1007/BF01540869 1502950