The treatment of patients with posthemorrhagic hydrocephalus

The article discusses the possible causes of polycystic posthemorrhagic ventriculomegaly in infants, as well as predictors of this pathological process. When choosing a treatment method the doctor shall take into account not only the etiology of the disease, but also age parameters, concomitant pathology. An important aspect in the approach to the treatment of polycystic posthemorrhagic multilevel hydrocephalus includes the determination of the biomechanical properties of the craniospinal system, especially the compliance of the brain and resorption of cerebrospinal fluid. Particular attention is paid to the timely correction of complications, including the analysis of inflammatory changes markers in the craniospinal system, which serve as predictors of the outcome of cerebrospinal fluid resorption. The authors also noted that the violation of the cerebrospinal fluid outflow from the cranial cavity in children may depend on a large number of «extracerebral» factors. They consider the stages of neurosurgical care to patients in this group on a clinical example. This example and literature data demonstrate that children with age develop changes not only in the craniospinal segment, which is responsible for the transformation of free fluid, but also in the extracranial cavities. Thus, we are able to recommend an integrated approach for the management of newborns with intracranial hemorrhage, complicated by posthemorrhagic hyporesorbent and occlusive hydrocephalus, with the justification of the optimal neurosurgical tactics for managing drainage-dependent patients, the course of the disease in which is accompanied by a multicomponent inflammatory syndrome.

1. Lobanov A.I., Lobanova O.G. Hemorrhagic disease of the newborn with late debut. Voprosy sovremennoj pediatrii 2011; 10(1): 167–171. (in Russ.)

2. Ceratto S., Savino F. Vitamin K deficiency bleeding in an apparently healthy newborn infant: the compelling need for evidence-based recommendation. Italian Journal of Pediatrics 2019; 45: 30. DOI: 10.1186/s13052-019-0625-y

3. Woods C.W., Woods A.G., Cederholm C.K. Vitamin K Deficiency Bleeding. Advances in Neonatal Care 2013; 13(6): 402–407. DOI: 10.1097/ANC.0000000000000026

4. Zurynski Y., Grover C.J., Jalaludin B., Elliott E.J. Vitamin K deficiency bleeding in Australian infants 1993–2017. Australian Paediatric Surveillance Unit study. Archives of Disease in Childhood 2020; 105: 433–438. DOI: 10.1136/archdischild-2018-316424

5. Habibi Z., Ertiaei A., Nikdad M.S., Mirmohseni A.S., Afarideh M., Heidari V. et al. Predicting ventriculoperitoneal shunt infection in children with hydrocephalus using artificial neural network. Childs Nerv Syst 2016; 32: 2143–2151. DOI: 10.1007/s00381-016-3248-2

6. Orlov Yu.A., Tkachik I.P., Shaverskij A.V., Plavskij N.V., Marushchenko L.L. Inflammatory complications of cerebrospinal fluid shunt operations. Ukrainskii neirokhirurgicheskii zhurnal 2007; 1: 44–49. (in Russ.)

7. Hahcatryan V.A., Samochernykh K.A. Endoscopy in child neurosurgery. Saint-Petersburg: Branko, 2015: 276. (in Russ.)

8. McClugage S.G., Laskay N.M.B., Donahue B.N., Arynchyna A., Zimmerman K., Aban I.B. et al. Functional outcomes at 2 years of age following treatment for posthemorrhagic hydrocephalus of prematurity: what do we know at the time of consult? J. Neurosurg Pediatr 2020: 1–9. DOI: 10.3171/2019.12.PEDS19381

9. Orvin K., Bilavsky E., Weiner E., Shouval D.S., Amir J. Successful antibiotic eradication of Streptococcus pneumoniae infection of a ventriculoatrial shunt. J Infect Dis 2009; 13(3):101–103. DOI: 10.1016/j.ijid.2008.07.008

10. Sakhno L.V. Diagnosis of hydrocephalus in children at the prehospital stage. Neirokhirurgiya i nevrologiya detskogo vozrasta 2009; 2: 12–20. (in Russ.)

11. Burström G., Andresen M., Bartek J. Jr., Fytagoridis A. Subacute bacterial endocarditis and subsequent shunt nephritis from ventriculoatrial shunting 14 years after shunt implantation. BMJ Case Rep 2014; 2014: bcr2014204655. DOI:10.1136/bcr-2014-204655

12. Hachatryan V.A., Samochernyh K.A., Kim A.V., Nikolaenko M.S., Sysoev K.V., Don O.A. et al. Ventriculo-sinustransversostomy in the treatment of decompensated hydrocephalus in children. Translyatsionnaya meditsina 2017; 4(1): 20–28. (in Russ.) DOI: 10.18705/2311-4495-2017-4-1-20-28

13. Wellons J.C., Shannon C.N., Holubkov R., Riva-Cambrin J., Kulkarni A.V., Limbrick D. Jr. et al. Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study. J Neurosurg Pediatr 2017; 20(1): 19–29. DOI: 10.3171/2017.1.PEDS16496

14. Chmutin G.E., Kim V.G., Poshataev K.E., Makarov K.V., Rubin A.B. Liquor-shunting surgery in the treatment of epilepsy with hydrocephalic syndrome. Dal’nevostochnyi meditsinskii zhurnal 2005; 4: 94–98. (in Russ.)

15. Foong K.S., Lee A., Vasquez G. Cryptococcal infection of the ventriculoperitoneal shunt in an immunocompetent patient. Am J Case Rep 2016; 17: 31–34. DOI: 10.12659/AJCR.896171

16. Hachatryan V.A., Poshataev K.E., Dallakyan N.O. Problems of surgery of epilepsy. Neirokhirurgiya i nevrologiya Kazahstana 2012; 2: 27–28. (in Russ.)

17. Simon T.D., Mayer-Hamblett N., Whitlock K.B., Langley M., Kestle J.R., Riva-Cambrin J. et al. Few patient, treatment, and diagnostic or microbiological factors, except complications and intermittent negative cerebrospinal fluid (CSF) cultures during first CSF shunt infection, are associated with reinfection. J Pediatr Inf Dis Soc 2014; 3(1): 1522. DOI: 10.1093/jpids/pit050

18. Erekeshov A.E., Razumov A.A., Kuz’min V.D., Asilbekov U.E., Kul’manov H.B., Razumov S.A. Intracranial complications of late hemorrhagic disease of the newborn. Neirokhirurgiya i nevrologiya Kazahstana 2012; 4(29): 16–20. (in Russ.)

19. Kamate M., Detroja M., Hattiholi V. Late-onset hemorrhagic disease of a newborn mimicking an atypical teratoid/rhabdoid tumor. Neurol India 2019; 67: 1566–1567. DOI: 10.4103/0028-3886.273655

20. Clark D.J., Chakraborty A., Roebuck D.J., Thompson D.N.P. Ultrasound guided placement of the distal catheter in paediatric ventriculoatrial shunts–an appraisal of efficacy and complications. Child’s Nervous System 2016; 32: 1219–1225. DOI: 10.1007/s00381-016-3120-4

21. Nash D.L., Schmidt K. Complications and management of ventriculoatrial (VA) shunts, a case report. Cerebrospinal Fluid Research 2010; 7(1): 42. DOI: 10.1186/1743-8454-7-S1-S42

22. Zhang J., Qu C., Wang Z., Wang C., Ding X., Pan S. et al. Improved ventriculoatrial shunt for cerebrospinal fluid diversion after multiple ventriculoperitoneal shunt failures. Surg Neurol 2009; 72: 29–33. DOI: 10.1016/j.surneu.2008.03.040

23. Al-Schameri A.R., Hamed J., Baltsavias G., Winkler P., Machegger L., Richling B., Emich S. Ventriculoatrial Shunts in Adults, Incidence of Infection, and Significant Risk Factors: A Single-Center Experience. World Neurosurg 2016; 94:345–351. DOI: 10.1016/j.wneu.2016.07.002

24. Lovga M.I, Chomolyak Yu.Yu. Treatment of intraventricular hemorrhage in newborns. Ukrainskii neirokhirurgicheskii zhurnal 2019; 25(2): 5–11. (in Russ.)

25. Kebriaei M., Shoja M.M., Salinas S.M., Falkenstrom K.L., Sribnick E.A., Tubbs R.S. et al. Shunt infection in the first year of life. Clinical article. J Neurosurg Pediatr 2013; 12(1): 44–48

26. Sorar M., Er U., Öziúik P., Özeren E., ùimúek’ S. The impact of antibiotic-impregnated catheters on ventriculoperitoneal shunt infection. Turk J Med Sci 2014; 44: 393–396. DOI: 10.3906/sag-1306-15

27. Schubert-Bast S., Berghaus L., Filmann N., Freiman T., Strzelczyk A., Kieslich M. Risk and risk factors for epilepsy in shunt-treated children with hydrocephalus. Eur J Paediatr Neurol 2019: 23(6): 819–826. DOI: 10.1016/j.ejpn.2019.09.004

28. Keene D.L. Hydrocephalus and epileptic seizures. Child’s Nervous System 1999; 15: 158–162

29. Klepper J., Büsse M., Straßburg H.M. Epilepsy in shunt-treated hydrocephalus. Dev Med Child Neurol 1998; 40: 731–736. DOI: 10.1111/j.1469-8749

30. Sato O., Yamguchi T., Kittaka M. Hydrocephalus and epilepsy. Childs Nerv Syst 2001; 17: 76–86