Shunt revision requirements after posthemorrhagic hydrocephalus of prematurity: insight into the time course of shunt dependency
Shunt revision requirements after posthemorrhagic hydrocephalus of prematurity: insight into the time course of shunt dependency
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DOI：
10.1007/s00381-015-2865-5
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发表时间：
2015-11-01
影响因子：
1.4
通讯作者：
Ahn, Edward S.
中科院分区：
文献类型：
--
作者：
Wang, Joanna Y.;Jackson, Eric M.;Ahn, Edward S.
脑室内出血（IVH）是一种常见的痛苦的早产儿，往往导致出血性脑积水（PHH）。这些患者通常最终需要永久性脑脊液分流，并被认为是无限期分流依赖。然而，到目前为止，还没有关于PHH患者长期分流翻修需求的研究。我们回顾性分析了1998年至2011年在我院诊断为III级和IV级IVH和PHH的89例早产儿的数据。89例患者中69例（77.5%）接受了脑室-腹膜（VP）分流术放置，33例（47.8%）需要至少一次分流术翻修，18例（26.1%）需要多次翻修。分流患者的平均+/-标准差随访时间为5.0 +/- 3.3年。大多数早期失败是由于近端导管故障，而后期失败主要是由于远端导管问题。在初始VP分流器插入后的前3年内需要翻修的患者数量与3年后相比有显著差异，28例翻修与10例翻修（p < 0.004）。在3年后接受分流术翻修的10例患者中，有8例在影像学上发现阻塞性脑积水的证据，表现为孤立的第四脑室囊肿或导水管狭窄。我们的研究结果表明，在PHH患者的一个独特的亚群中，梗阻性脑积水可能会发展，导致长期依赖脑脊液分流。在PHH组中，有必要进一步研究与长期分流依赖和翻修需求相关的因素。
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.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.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 +/- A standard deviation follow-up time for shunted patients was 5.0 +/- A 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.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.