Zaben Malik, Finnigan Amy, Bhatti Muhammed I, Leach Paul
a Institute of Psychological Medicine and Clinical Neurosciences, National Neuroscience and Mental Health Research Institute, Cardiff University School of Medicine , Cardiff , UK.
b Department of Paediatric Neurosurgery , University Hospital of Wales , Cardiff , UK.
Br J Neurosurg. 2016;30(1):7-10. doi: 10.3109/02688697.2015.1096911. Epub 2015 Oct 15.
Post-haemorrhagic hydrocephalus (PHH), a potential consequence of grade II-IV germinal matrix haemorrhage, remains a significant problem in premature infants with long-term neurodevelopmental disabilities and high mortality rates. Early ventriculoperitoneal shunt (VPS) insertion is associated with a high failure rate and many complications; hence, temporising measures are always instituted until the infant is mature (age and/or weight) enough.
We have reviewed the recently available literature on the usefulness and complications of the initial measures used in the treatment of PHH; particularly, focusing on serial cerebrospinal fluid (CSF) tapping, external ventricular drainage (EVD), ventriculosubgaleal shunts (VSG), ventricular access devices (VADs), endoscopic third ventriculostomy (ETV) with and without coagulation of the choroid plexus.
Randomised controlled trials (RCTs) have failed to demonstrate a significant effect of serial lumbar punctures on the rates of morbidity, mortality or conversion to permanent VPS in the treatment of PHH. Retrospective studies, mostly with small patients' numbers, provide not only a considerable controversy regarding EVD, VSG, VADs and ETV usefulness in the management of PHH but also variable rates on their complications. None of these variables have, however, been tested using RCTs.
There is no level-one evidence to support the superiority of any of the currently available temporising measures in the initial treatment of PHH over others. The need for such rigorous studies remains largely unmet. We feel that a UK multi-centre-RCT is paramount to provide neurosurgeons with the evidence needed to choose the best initial approach for PPH treatment, yet with minimal complications' rate.
出血后脑积水（PHH）是II-IV级生发基质出血的潜在后果，在患有长期神经发育障碍和高死亡率的早产儿中仍然是一个重大问题。早期脑室腹腔分流术（VPS）置入的失败率高且并发症多；因此，总是采取临时措施，直到婴儿足够成熟（年龄和/或体重）。
我们回顾了最近关于PHH治疗中使用的初始措施的有效性和并发症的文献；特别关注连续脑脊液（CSF）穿刺、脑室外引流（EVD）、脑室-帽状腱膜下分流术（VSG）、脑室接入装置（VAD）、有无脉络丛凝固的内镜下第三脑室造瘘术（ETV）。
随机对照试验（RCT）未能证明连续腰椎穿刺在治疗PHH时对发病率、死亡率或转为永久性VPS的发生率有显著影响。回顾性研究大多样本量小，不仅在EVD、VSG、VAD和ETV在PHH管理中的有效性方面存在很大争议，而且其并发症发生率也各不相同。然而，这些变量均未通过RCT进行测试。
没有一级证据支持目前任何一种PHH初始治疗临时措施优于其他措施。对这类严谨研究的需求在很大程度上仍未得到满足。我们认为，英国多中心RCT对于为神经外科医生提供选择PPH最佳初始治疗方法所需的证据至关重要，同时并发症发生率最低。
