Initial experience with combined endoscopic third ventriculostomy and choroid plexus cauterization for post-hemorrhagic hydrocephalus of prematurity: the importance of prepontine cistern status and the predictive value of FIESTA MRI imaging
Tóm tắt
Post-hemorrhagic hydrocephalus of prematurity (PHHP) is among the most common causes of infant hydrocephalus in developed nations. This population has a high incidence of shunt failure, infection, and slit ventricle syndrome. Although effective for other etiologies of infant hydrocephalus, the efficacy of combined endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC) in PHHP has not been investigated. This pilot study reports the initial experience. Ten patients (four grade III and six grade IV intraventricular hemorrhage) requiring definitive treatment for PHHP underwent ETV/CPC within 6 months of birth. Seven had a prior ventriculo-subgaleal shunt. Mean age at birth was −12.8 weeks, or 25.2 weeks gestation (24–28 weeks), and at surgery was −1.6 weeks (−11 to +11 weeks). Mean weight at surgery was 3.3 (1.0–5.5 kg). Each patient had preoperative magnetic resonance imaging (MRI) with fast imaging employing steady-state acquisition (FIESTA). Four of ten (40%) required no further operations related to hydrocephalus (mean follow-up, 29.7 months). Six required another procedure (five ultimately shunted). Prepontine cistern status correlated with outcome (p = 0.033). Procedures in all infants with unobstructed cisterns were successful but failed in six of seven with cisternal obstruction, with the one success having an alternative lamina terminalis endoscopic third ventriculostomy. Preoperative MRI FIESTA images correlated well with intraoperative assessment of the cistern. Results from this small homogenous cohort suggest cistern status is an important determinant of outcome. FIESTA imaging correlated with endoscopic observation. Preliminary analysis suggests ETV/CPC as an effective treatment for PHHP, but only when the cistern is unscarred. This information should guide patient selection for future study protocols.
Tài liệu tham khảo
National Institute of Neurologic Disorders and Stroke: Hydrocephalus: Myths, New Facts, Clear Directions. Bethesda, MD: NINDS (2005) http://www.ninds.nih.gov/news_and_events/proceedings/Hydrocephalus_2005.htm (last accessed June 7, 2010)
Child Health USA 2003, United States Department of Health and Human Services (2003) http://mchb.hrsa.gov/chusa03/pages/status.htm (last accessed June 7, 2010)
Linder N, Haskin O, Levit O, Klinger G, Prince T, Naor N, Turner P, Sirota L, Karmazyn B (2003) Risk factors for intraventricular hemorrhage in very low birth weight premature infants: a retrospective case-control study (2003). Pediatrics 111(5):590–595
Martins L, Borges MJ, Gomes SM, Macedo I, Nona J, Pinto F, Faria C, Nascimento O, Valido AM. (2009) Intraventricular hemorrhage risk factors in very low birth weight newborns: a case-control study. Einstein 7 (3 Pt 1): 279–83 http://apps.einstein.br/revista/arquivos/PDF/1345-Einstein%20v7n3p279-83.pdf (last accessed June 7, 2010)
Wellons JC, Shannon CN, Kuklkarni AV, Simon TD, Riva-Cambrin J, Whitehead WE, Oakes WJ, Drake JM, Luerssen TG, Walker ML, Kestle JR (2009) A multicenter retrospective comparison of conversion from temporary to permanent cerebrospinal fluid diversion in very low birth weight infants with posthemorrhagic hydrocephalus. J Neurosurg Pediatr 4:50–55
Boop FA (2004) Posthemorrhagic hydrocephalus of prematurity. In: Cinalli G, Maixner WJ, Sainte-Rose C (eds) Pediatric Hydrocephalus. Springer, Milano, pp 121–131
Drake JM, Kestle JR, Milner R, Cinalli G, Boop F, Piatt J Jr et al (1998) Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 43:294–305
Beems T, Grotenhuis JA (2002) Is the success rate of endoscopic third ventriculostomy age-dependent? An analysis of the results of endoscopic third ventriculostomy in young children. Childs Nerv sys 18:605–608
Boynton B, Boynton C, Merritt A, Vaucher YE, James HE, Bejar RF et al (1986) Ventriculoperitoneal shunts in low birth weight infants with intracranial hemorrhage: neurodevelopmental outcome. Neurosurgery 18:141–145
Resch B, Gedermann A, Maurer U, Ritschl E, Müller W (1996) Neurodevelopmental outcome of hydrocephalus following intra-/periventricular hemorrhage in preterm infants: short- and long-term results. Child’s Nerv Syst 12:27–33
Levy M, Masri L, McComb J (1997) Outcome for preterm infants with germinal matrix hemorrhage and progressive hydrocephalus. Neurosurgery 41:1111–1118
Javadpour M, Malluci C, Brodbelt A, Golash A, Mary P (2001) The impact of endoscopic third ventriculostomy on the management of newly diagnosed hydrocephalus in infants. Peditatr Neurosurg 35:131–135
Buxton N, Macarthur D, Mallucci C, Punt J, Vloeberghs M (1998) Neuroendoscopic third ventriculostomy in patients less than 1 year old. Pediatr Neurosurg 29:73–76
Siomin V, Cinalli G, Grotenhuis A, Golash A, Oi S, Kothbauer K et al (2002) Endoscopic third ventriculostomy in patients with cerebrospinal fluid infection and/or hemorrhage. J Neurosurg 97:519–524
Warf BC (2005) Comparison of endoscopic third ventriculostomy alone and combined with choroid plexus cauterization in infants younger than 1 year of age: a prospective study in 550 African children. J Neurosurg 103(6):475–481
Warf BC, Kulkarni AV (2010) Intraoperative assessment of cerebral aqueduct patency and cisternal scarring: impact on success of endoscopic third ventriculostomy in 403 African children. J Neurosurg Pediatr 5:204–209
Warf BC, Mugamba J, Kulkarni A (2010) Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus in Uganda: report of a scoring system that predicts success. J Neurosurg Pediatr 5:143–148
Warf BC (2005) Hydrocephalus in Uganda: the predominance of infectious origin and primary management with endoscopic third ventriculostomy. J Neurosurg 102(1):1–15
Sainte-Rose C, Hoffman HJ, Hirsch JF (1989) Shunt failure. Concepts pediatric neurosurgery 9:7–20
Drake J, Chumas P, Kestle J, Pierre-Kahn A, Vinchon M, Brown J, Pollack IF, Arai H (2006) Late rapid deterioration after endoscopic third ventriculostomy: additional cases and review of the literature. J Neurosurg 105(2 Suppl):118–126
Warf BC, Campbell JW (2008) Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment of hydrocephalus for infants with myelomeningocele: long-term results of a prospective intent-to-treat study in 115 East African infants. J Neurosurg Pediatr 2:310–316
Casey AT, Kimmings EJ, Kleinlugtebeld AD, Taylor WA, Harkness WF, Hayward RD (1997) The long-term outlook for hydrocephalus in childhood. A ten-year cohort study of 155 patients. Pediatr Neurousrg 27:63–70
Piatt JH Jr, Cosgriff M (2007) Monte Carlo simulation of cerebrospinal fluid shunt failure and definition of instability among shunt-treated patients with hydrocephalus. J Neurosurg 107(6 Suppl):474–478
Stein SC, Guo W (2007) A mathematical model of survival in a newly inserted ventricular shunt. J Neurosurg 107(6 Suppl):448–454
Warf BC (2005) Comparison of one-year outcomes for the Chhabra and Codman-Hakim Micro Precision shunt systems in Uganda: a prospective study in 195 children. J Neurosurg 102(4):358–362
St George E, Natarajan K, Sgouros S (2004) Changes in ventricular volume in hydrocephalic children following successful endoscopic third ventriculostomy. Childs Nerv Syst 20:834–838
Hanlo PW (1995) Noninvasive intracranial pressure monitoring in infantile hydrocephalus and the relationship with transcranial Doppler, myelination and outcome. Thesis, Utrecht, The Netherlands
Hanlo PW, Gooskens HJM, Vandertop PW (2004) Hydrocephalus: intracranial pressure, myelination, and neurodevelopment. In: Cinalli G, Maixner WJ, Sainte-Rose C (eds) Pediatric Hydrocephalus. Springer-Verlag Italia, Milan, pp 113–119
Hanlo PW, Gooskens RJ, van Schooneveld M, Tulleken CA, van der Knaap MS, Faber JA, Willemse J (1997) The effect of intracranial pressure on myelination and the relationship with neurodevelopment in infantile hydrocephalus. Dev Med Child Neurol 39(5):286–291
van der Knaap MS, Valk J, Bakker CJ, Schooneveld M, Faber JA, Willemse J, Gooskens RH (1991) Myelination as an expression of the functional maturity of the brain. Dev Med Child Neurol 33:849–857
Warf BC, Ondoma S, Kulkarni AV, Donnelly R, Ampeire M, Akona J, Kabachelor CR, Mulondo R, Nsubuga BK (2009) Neurocognitive outcome and ventricular volume in myelomeningocele children treated for hydrocephalus in Uganda. J Neurosurg Pediatr 4:564–570
Oi S, Matsumoto S (1987) Infantile hydrocephalus and the slit ventricle syndrome in early infancy. Childs Nerv Syst 3(3):145–150