Management of hydrocephalus secondary to intraventricular hemorrhage in the preterm infant with a subcutaneous ventricular catheter reservoir.
Management of hydrocephalus secondary to intraventricular hemorrhage in the preterm infant with a subcutaneous ventricular catheter reservoir.
复制标题
使用皮下脑室导管储液器治疗早产儿脑室内出血继发的脑积水。
作者：
G. McComb;A. Ramos;A. Platzker;Diane J. Henderson;H. Segall
为了控制患有呼吸窘迫综合征的早产儿因大量脑室内出血而导致的脑积水，我们在出生后第 12 天（平均；范围为 3 至 30 天）为 20 名平均出生体重为 1110 +/- 270 g（妊娠 28.7 +/- 1.6 周）的新生儿插入了专门设计的薄型皮下脑室导管储库（储库）。在 10 至 48 天内反复对储液池进行抽吸。没有发生脑脊液感染、储库阻塞或储库上方皮肤破裂的情况。系列计算机断层扫描记录了幸存者脑积水的控制和皮质套厚度的增加。没有死亡与储液器的放置或随后将其转换为脑室腹膜分流术（如有必要）相关。然而，20名婴儿中只有7人幸存。 3 至 5 年后的随访中，7 人中有 2 人智力和运动发育正常。两个婴儿智力正常，但有运动缺陷。其余 3 名患者均存在明显的智力和运动发育迟缓。使用储液器可作为重复心室穿刺、脑室外引流或初始分流的安全有效的替代方案。积极治疗脑室内出血继发的脑积水可能会改善一些幸存新生儿的神经功能。
To control hydrocephalus resulting from massive intraventricular hemorrhage in premature neonates with respiratory distress syndrome, we inserted a specially designed low profile subcutaneous ventricular catheter reservoir (reservoir) by the 12th day of life (average; range, 3 to 30 days) in 20 neonates whose mean birth weight was 1110 +/- 270 g (28.7 +/- 1.6 weeks of gestation). The reservoir was repeatedly aspirated over 10 to 48 days. No cerebrospinal fluid infection, reservoir obstruction, or breakdown of the skin overlying the reservoir occurred. Serial computed tomographic scans documented control of the hydrocephalus and an increase in the thickness of the cortical mantle of the survivors. No mortality was associated with placement of the reservoir or its subsequent conversion, if necessary, to a ventriculoperitoneal shunt. However, only 7 of the 20 infants survived. On follow-up 3 to 5 years later, 2 of the 7 have normal intellectual and motor development. Two infants are normal intellectually, but have a motor deficit. The remaining 3 patients have both significant intellectual and motor developmental delay. The use of the reservoir is offered as a safe and effective alternative to repeated ventricular punctures, external ventricular drainage, or initial shunting. Aggressive management of hydrocephalus secondary to intraventricular hemorrhage may improve neurological function in some surviving neonates.