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A tailored approach to the management of post-haemorrhagic hydrocephalus
Child's Nervous System ( IF 1.3 ) Pub Date : 2023-11-12 , DOI: 10.1007/s00381-023-06214-6
Benjamin J Hall 1, 2, 3 , John C Duddy 1 , Katerina Apostolopoulou 1 , Benedetta Pettorini 1
Affiliation  

Purpose

Neuro-endoscopic lavage (NEL) is an increasingly popular intervention for intraventricular haemorrhage (IVH) and post-haemorrhagic hydrocephalus (PHH), with considerable variation in technique dependent on clinician and clinical circumstances. Whilst efforts to standardise the technique are ongoing, this work describes a tertiary centre experience utilising NEL, highlighting potential caveats to standardisation.

Methods

A retrospective review of electronic case notes for patients undergoing temporising surgical intervention for IVH between 2012 and 2021 at our centre was performed. Data collected included (i) gestational age, (ii) aetiology of hydrocephalus, (iii) age at time of intervention, (iv) intervention performed, (v) need for permanent CSF diversion, (vi) ‘surgical burden’, i.e. number of procedures following primary intervention, and (vii) wound failure and infection rate. Data was handled in Microsoft Excel and statistical analysis SPSS v27.0

Results

49 neonates (n = 25 males) were included. Overall mean gestational age was 27 weeks and at intervention 35 + 3 weeks. IVH was the predominant cause of hydrocephalus (93.8%) and primary surgical interventions included insertion of a ventriculosubgaleal shunt (VSGS) in n = 41 (83.6%) patients, NEL in n = 6 (12.2%) patients and insertion of an EVD in n = 2 (4.1%). N = 9 (18.4%) patients underwent NEL at some point during the time interval reviewed; n = 4 (8.2%) received NEL monotherapy and n = 5 (10.2%) also received a VSGS. Rate of conversion to definitive CSF diversion between NEL (n = 8, 88.9%) and VSGS cohorts (n = 37, 92.5%) was not significantly different (p = 0.57), nor between NEL alone (n = 3, 75%) and NEL + VSGS (n = 5, 100%) (p = 0.44). None of the patients that underwent NEL monotherapy had any wound issues or CNS infection as a result of the initial intervention, compared to n = 3 (60%) of those that underwent NEL and implantation of VSGS (p = 0.1).

Conclusion

Both NEL and VSGS are effective in temporising hydrocephalus in neonates, occasionally offering a definitive solution in and of themselves. The benefit of dual therapy however remains to be seen, with the addition of VSGS potentially increasing the risk of wound failure in an already vulnerable cohort.



中文翻译:


出血后脑积水的定制治疗方法


 目的


神经内镜灌洗 (NEL) 是治疗脑室内出血 (IVH) 和出血后脑积水 (PHH) 的一种日益流行的干预措施,其技术差异很大,具体取决于临床医生和临床情况。虽然标准化该技术的努力正在进行中,但这项工作描述了利用 NEL 的三级中心的经验,强调了标准化的潜在注意事项。

 方法


对 2012 年至 2021 年间在我们中心接受临时 IVH 手术干预的患者的电子病例记录进行了回顾性审查。收集的数据包括(i)胎龄,(ii)脑积水的病因,(iii)干预时的年龄,(iv)进行的干预,(v)永久脑脊液转移的需要,(vi)“手术负担”,即数量初步干预后的程序,以及 (vii) 伤口失败和感染率。数据在 Microsoft Excel 中处理并进行统计分析 SPSS v27.0

 结果


包括 49 名新生儿( n = 25 名男性)。总体平均孕龄为 27 周,干预时为 35 + 3 周。 IVH 是脑积水的主要原因 (93.8%),主要手术干预措施包括在n = 41 例 (83.6%) 患者中插入脑室帽状脑分流术 (VSGS),在 n = 6 例 (12.2%) 患者中插入 NEL,以及在n = 6 例 (12.2%) 患者中插入 EVD。 n = 2 (4.1%)。 N = 9 (18.4%) 名患者在审查的时间间隔内的某个时间点接受了 NEL; n = 4 (8.2%) 接受 NEL 单药治疗, n = 5 (10.2%) 还接受 VSGS。 NEL ( n = 8, 88.9%) 和 VSGS 队列 ( n = 37, 92.5%) 之间的转化为明确的脑脊液转移率没有显着差异 ( p = 0.57),单独 NEL 之间 ( n = 3, 75%) 之间也没有显着差异和 NEL + VSGS ( n = 5, 100%) ( p = 0.44)。接受 NEL 单一疗法的患者均未因初始干预而出现任何伤口问题或 CNS 感染,而接受 NEL 和 VSGS 植入的患者中有n = 3 (60%) ( p = 0.1)。

 结论


NEL 和 VSGS 都能有效缓解新生儿脑积水,有时本身也能提供明确的解决方案。然而,双重治疗的好处仍有待观察,因为添加 VSGS 可能会增加本已脆弱的人群伤口失败的风险。

更新日期:2023-11-12
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