Hydrocephalus temporisation with ventricular reservoir or trans-fontanelle ventricular taps for intraventricular haemorrhage of prematurity: A retrospective cohort study

Abstract

PURPOSE: Hydrocephalus following intraventricular haemorrhage of prematurity (post haemorrhagic ventricular dilation/PHVD) is one of the most common causes of paediatric hydrocephalus. There is little evidence regarding the role of trans-fontanelle ventricular taps (TFVT) as a temporising strategy in the early management of these patients. This study aimed to compare the safety and efficacy of TFVT with the use of a ventricular reservoir/access device. METHODS: A retrospective review of prospectively maintained databases was conducted, including all patients who received a diagnosis of intraventricular haemorrhage or PHVD at the two major neonatal intensive care units in the State of Queensland, Australia between 1st January 2016 to 31st December 2022. Followup data was obtained from review of statewide electronic medical records. RESULTS: The medical records of 910 low birth-weight infants with intraventricular haemorrhage were screened. Of these, 28 patients underwent placement of a ventricular reservoir and 36 underwent serial TFVT alone. There were no statistically significant differences in rates of ventriculoperitoneal shunt insertion (83 % vs 75 %, p = 0.41). There were no significant differences in mortality or two year Paediatric modified Rankin Scale. No clinically significant intracranial haemorrhages occurred in either group. CSF leak was more common from the ventricular reservoir wound (14 % vs 3 %, p = 0.02). There was no significant difference in the incidence of CSF infection between the cohorts (6 % vs 4 %, p = 0.71). CONCLUSION: This study provides level III evidence to suggest that trans-fontanelle ventricular taps may have a similar safety and efficacy profile to the use of a ventricular reservoir.