Primary intervention for posthemorrhagic hydrocephalus in very low birthweight infants by ventriculostomy

The objective of our study was to determine the efficacy of ventriculostomy as the primary treatment for posthemorrhagic hydrocephalus in premature in fants. Within a period of 4 years, 20 very low birthweight (VLBW) infants ( birthweight median 1135 g, range 650-1470 g) were treated for progressive p osthemorrhagic hydrocephalus (PHHC) by right parietal ventriculostomy (Salm on Rickham) at a mean age of 21 days. Serial tapping of the subcutaneous re servoir was performed for temporary drainage until conversion to a permanen t ventriculoperitoneal (VP) shunt or spontaneous resolution of hydrocephalu s. A total of 1402 punctures (median 71 / infant, range 13-168) was perform ed. The results showed that only 1/20 patients developed a cerebrospinal fl uid (CSF) infection, accounting for a 5% patient-related and 0.07% procedur e-related infection rate. Major complications such as skin defects, subdura l hygroma, or CSF leaks occurred in three patients (15%). A permanent shunt was needed in 17 patients (85%). We concluded that, as an effective altern ative to serial or lumbar puncture, there should be early implantation of v entriculostomy reservoirs for serial taps-to control intracranial pressure in PHHC of VLBW infants until a permanent shunt can be placed because of th e low incidence of infections and technical complications.