J Neurol Surg A Cent Eur Neurosurg 2013; 74(02): 082-086
DOI: 10.1055/s-0032-1320023
Original Article
Georg Thieme Verlag KG Stuttgart · New York

A Survey on Current Practice in the Neurosurgical Management of Preterm Infants with Posthemorrhagic Hydrocephalus in Germany

Uwe Max Mauer
1   Department of Neurosurgery, Armed Forces Hospital, Ulm, Germany
Luise Unterreithmeir
1   Department of Neurosurgery, Armed Forces Hospital, Ulm, Germany
Arne Jahn
1   Department of Neurosurgery, Armed Forces Hospital, Ulm, Germany
Wolfgang Wagner
2   Department of Neurosurgery, University of Mainz, Mainz, Germany
Ulrich Kunz
1   Department of Neurosurgery, Armed Forces Hospital, Ulm, Germany
Chris Schulz
1   Department of Neurosurgery, Armed Forces Hospital, Ulm, Germany
› Author Affiliations
Further Information

Publication History

31 August 2011

05 January 2012

Publication Date:
18 December 2012 (online)


Background and Study Aims Different approaches to the management of preterm infants with posthemorrhagic hydrocephalus (PHH) are described in the literature. Likewise, neurosurgical and pediatric surgical departments in German hospitals use different methods to treat these patients. The aim of this study was therefore to assess the current situation regarding the management of PHH, which is a first and essential step toward the development of standards of practice.

Patients and Methods In the second half of 2009, we sent standardized questionnaires to 139 neurosurgical departments (number of returned questionnaires: 98) and 73 pediatric surgical departments (returned questionnaires: 62) to identify the principles of PHH management. Preterm infants with PHH are treated in 61 of the neurosurgical and in 20 of the pediatric surgical departments.

Results 43 of the 61 neurosurgical departments and 17 of the 20 pediatric surgical departments providing care for preterm infants with PHH treat less than 10 preterm infants with PHH per year. Reservoir placement is performed as the initial treatment in 48 neurosurgical and in 14 pediatric surgical departments.

The criteria for the placement of ventriculoperitoneal shunts and the implantation procedure itself are highly variable. Moreover, the percentage of children who require a CSF shunt after initial treatment for PHH ranges between 5 and 95%.

Conclusions In Germany, the type of treatment of infants with PHH differs from institution to institution. Clear and consistent guidelines must be established in an interdisciplinary approach to improve and better coordinate the management of infants with PPH.

  • References

  • 1 Cherian S, Whitelaw A, Thoresen M, Love S. The pathogenesis of neonatal post-hemorrhagic hydrocephalus. Brain Pathol 2004; 14 (3) 305-311
  • 2 Gurtner P, Bass T, Gudeman SK, Penix JO, Philput CB, Schinco FP. Surgical management of posthemorrhagic hydrocephalus in 22 low-birth-weight infants. Childs Nerv Syst 1992; 8 (4) 198-202
  • 3 McCrea HJ, Ment LR. The diagnosis, management, and postnatal prevention of intraventricular hemorrhage in the preterm neonate. Clin Perinatol 2008; 35 (4) 777-792 , vii
  • 4 Ment LR, Oh W, Ehrenkranz RA , et al. Risk period for intraventricular hemorrhage of the preterm neonate is independent of gestational age. Semin Perinatol 1993; 17 (5) 338-341
  • 5 Benzel EC, Reeves JP, Nguyen PK, Hadden TA. The treatment of hydrocephalus in preterm infants with intraventricular haemorrhage. Acta Neurochir (Wien) 1993; 122 (3-4) 200-203
  • 6 Kazan S, Güra A, Uçar T, Korkmaz E, Ongun H, Akyuz M. Hydrocephalus after intraventricular hemorrhage in preterm and low-birth weight infants: analysis of associated risk factors for ventriculoperitoneal shunting. Surg Neurol 2005; 64 (Suppl. 02) S77-S81, discussion S81
  • 7 Whitelaw A, Cherian S, Thoresen M, Pople I. Posthaemorrhagic ventricular dilatation: new mechanisms and new treatment. Acta Paediatr Suppl 2004; 93 (444, Suppl) 11-14
  • 8 Love S. Acute haemorrhagic and hypoxic-ischaemic brain damage in the neonate. Curr Diagn Pathol 2004; 10 (2) 106-115
  • 9 Shooman D, Portess H, Sparrow O. A review of the current treatment methods for posthaemorrhagic hydrocephalus of infants. Cerebrospinal Fluid Res 2009; 6: 1-15
  • 10 Whitelaw A. Intraventricular haemorrhage and posthaemorrhagic hydrocephalus: pathogenesis, prevention and future interventions. Semin Neonatol 2001; 6 (2) 135-146
  • 11 Chazal J. Management of hydrocephalus in childhood. In: Sindou M, , ed. Practical Handbook of Neurosurgery, Volume 2 Intracranial Tumors, Intraoperative Explorations, Pediatrics. Wien, New York: Springer; 2009: 525-541
  • 12 Cinalli G. Alternatives to shunting. Childs Nerv Syst 1999; 15 (11-12) 718-731
  • 13 Aldana PR, Steinbok P. Prioritizing neurosurgical education for pediatricians: results of a survey of pediatric neurosurgeons. J Neurosurg Pediatr 2009; 4 (4) 309-316
  • 14 Brouwer AJ, Groenendaal F, van den Hoogen A , et al. Incidence of infections of ventricular reservoirs in the treatment of post-haemorrhagic ventricular dilatation: a retrospective study (1992-2003). Arch Dis Child Fetal Neonatal Ed 2007; 92 (1) F41-F43
  • 15 Hudgins RJ, Boydston WR, Gilreath CL. Treatment of posthemorrhagic hydrocephalus in the preterm infant with a ventricular access device. Pediatr Neurosurg 1998; 29 (6) 309-313
  • 16 Richard E, Cinalli G, Assis D, Pierre-Kahn A, Lacaze-Masmonteil T. Treatment of post-haemorrhage ventricular dilatation with an Ommaya's reservoir: management and outcome of 64 preterm infants. Childs Nerv Syst 2001; 17 (6) 334-340
  • 17 Kormanik K, Praca J, Garton HJ, Sarkar S. Repeated tapping of ventricular reservoir in preterm infants with post-hemorrhagic ventricular dilatation does not increase the risk of reservoir infection. J Perinatol 2010; 30 (3) 218-221
  • 18 Pikus HJ, Levy ML, Gans W, Mendel E, McComb JG. Outcome, cost analysis, and long-term follow-up in preterm infants with massive grade IV germinal matrix hemorrhage and progressive hydrocephalus. Neurosurgery 1997; 40 (5) 983-988, discussion 988–989
  • 19 Willis B, Javalkar V, Vannemreddy P , et al. Ventricular reservoirs and ventriculoperitoneal shunts for premature infants with posthemorrhagic hydrocephalus: an institutional experience. J Neurosurg Pediatr 2009; 3 (2) 94-100
  • 20 Cornips E, Van Calenbergh F, Plets C, Devlieger H, Casaer P. Use of external drainage for posthemorrhagic hydrocephalus in very low birth weight premature infants. Childs Nerv Syst 1997; 13 (7) 369-374
  • 21 Rhodes TT, Edwards WH, Saunders RL , et al. External ventricular drainage for initial treatment of neonatal posthemorrhagic hydrocephalus: surgical and neurodevelopmental outcome. Pediatr Neurosci 1987; 13 (5) 255-262
  • 22 Vinchon M, Lapeyre F, Duquennoy C, Dhellemmes P. Early treatment of posthemorrhagic hydrocephalus in low-birth-weight infants with valveless ventriculoperitoneal shunts. Pediatr Neurosurg 2001; 35 (6) 299-304
  • 23 Whitelaw A, Thoresen M, Pople I. Posthaemorrhagic ventricular dilatation. Arch Dis Child Fetal Neonatal Ed 2002; 86: F72-F74
  • 24 Whitelaw A. Repeated lumbar or ventricular punctures for preventing disability or shunt dependence in newborn infants with intraventricular hemorrhage. Cochrane Database Syst Rev 2000; (2) CD000216
  • 25 Roland EH, Hill A. Intraventricular hemorrhage and posthemorrhagic hydrocephalus. Current and potential future interventions. Clin Perinatol 1997; 24 (3) 589-605
  • 26 Pulido-Rivas P, Martínez-Sarries FJ, Ochoa M, Sola RG. [Treatment of hydrocephalus secondary to intraventricular haemorrhage in preterm infants. A review of the literature]. Rev Neurol 2007; 44 (10) 616-624
  • 27 Heep A, Engelskirchen R, Holschneider A, Groneck P. Primary intervention for posthemorrhagic hydrocephalus in very low birthweight infants by ventriculostomy. Childs Nerv Syst 2001; 17 (1-2) 47-51