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Posthemorrhagic Hydrocephalus

  • Jonathan A. Pindrik
  • Mark Halverson
Chapter

Abstract

Intraventricular hemorrhage (IVH) and posthemorrhagic hydrocephalus (PHH) represent two of the most common and debilitating conditions affecting premature neonates. With escalating grades of severity (Grade I–IV), the amount and extent of IVH influence rates of survival, risk of developing PHH requiring treatment, and neurocognitive outcomes. While the diagnosis of IVH relies solely on imaging modalities, the designation of PHH combines radiographic and clinical information. Treatment for PHH involves temporizing measures (typically ventriculo-subgaleal shunt or ventricular access device insertion) or permanent strategies (ventriculoperitoneal shunt [VPS] insertion or endoscopic third ventriculostomy with choroid plexus cauterization [ETV/CPC]) in the appropriate clinical setting. Improved neonatal care and these neurosurgical interventions have helped to reduce overall and hydrocephalus-related mortality rates in premature infants with IVH. However, mortality rates of premature infants with severe IVH remain high. Additionally, patients with severe IVH and PHH frequently exhibit neurocognitive impairment and elevated risks of developing cerebral palsy or epilepsy (Adams-Chapman et al., Pediatrics. 2008;121(5):e1167–77). Current research endeavors focus on the potential utility of cerebrospinal fluid biomarkers and rat models of IVH and PHH to trial novel preventive and therapeutic interventions.

Keywords

Germinal matrix Germinal matrix hemorrhage (GMH) Intraventricular hemorrhage (IVH) Posthemorrhagic hydrocephalus (PHH) Ventriculo-peritoneal shunt (VPS) 

Abbreviations

AF

Anterior fontanelle

AVM

Arteriovenous malformation

CP

Cerebral palsy

CSF

Cerebrospinal fluid

EI

Evans index

ELBW

Extremely low birth weight

ETV

Endoscopic third ventriculostomy

ETV/CPC

Endoscopic third ventriculostomy with choroid plexus cauterization

EVD

External ventricular drain

FOR

Frontal/occipital horn ratio

g

Grams

GA

Gestational age

GMH

Germinal matrix hemorrhage

HC

Head circumference

HCRN

Hydrocephalus Clinical Research Network

ICP

Intracranial pressure

IVH

Intraventricular hemorrhage

kg

Kilograms

LP

Lumbar puncture

MDI

Mental Developmental Index

ml

Milliliters

MRI

Magnetic resonance imaging

NICU

Neonatal intensive care unit

OR

Odds ratio

PDI

Psychomotor Development Index

PHH

Posthemorrhagic hydrocephalus

PHVD

Posthemorrhagic ventricular dilation

PVHI

Periventricular hemorrhagic infarction

PVL

Periventricular leukomalacia

RBC

Red blood cell

TGF-β

Transforming growth factor-β

US

Ultrasound

VAD

Ventricular access device

VAS

Ventriculoatrial shunt

VBR

Ventricular-brain ratio

VPS

Ventriculoperitoneal shunt

VSGS

Ventriculo-subgaleal shunt

VLBW

Very low birth weight

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Pediatric Neurosurgery, Department of Neurological SurgeryNationwide Children’s Hospital, The Ohio State University College of MedicineColumbusUSA
  2. 2.Department of RadiologyNationwide Children’s HospitalColumbusUSA

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