Abstract
Purpose: Intraventricular hemorrhage (IVH) is a common affliction of preterm infants and often results in posthemorrhagic hydrocephalus (PHH). These patients typically eventually require permanent CSF diversion and are presumed to be indefinitely shunt-dependent. To date, however, there has been no study of long-term shunt revision requirements in patients with PHH. Methods: We analyzed retrospectively collected data for 89 preterm patients diagnosed with grades III and IV IVH and PHH at our institution from 1998 to 2011. Results: Sixty-nine out of 89 patients (77.5 %) underwent ventriculoperitoneal (VP) shunt placement, and 33 (47.8 %) required at least one shunt revision and 18 (26.1 %) required multiple revisions. The mean ± standard deviation follow-up time for shunted patients was 5.0 ± 3.3 years. The majority of early failures were due to proximal catheter malfunction, while later failures were mostly due to distal catheter problems. There was a significant difference in the number of patients requiring revisions in the first 3 years following initial VP shunt insertion compared after 3 years, with 28 revisions versus 10 (p < 0.004). In 8 out of 10 patients who underwent shunt revisions after 3 years, evidence of obstructive hydrocephalus was found on imaging either in the form of an isolated fourth ventricular cyst or aqueductal stenosis. Conclusions: Our results suggest that in a distinct subset of patients with PHH, obstructive hydrocephalus may develop, resulting in long-term dependence on CSF diversion. Further study on the factors associated with long-term shunt dependence and revision requirements within the PHH group is warranted.
Original language | English (US) |
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Pages (from-to) | 2123-2130 |
Number of pages | 8 |
Journal | Child's Nervous System |
Volume | 31 |
Issue number | 11 |
DOIs | |
State | Published - Nov 1 2015 |
Keywords
- Hydrocephalus
- Intraventricular hemorrhage
- Posthemorrhagic hydrocephalus
- Revision
- Shunt
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Clinical Neurology