Department of Neurosurgery, Great Ormond Street Hospital, London, UK.
Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK.
Childs Nerv Syst. 2021 Nov;37(11):3375-3383. doi: 10.1007/s00381-021-05206-8. Epub 2021 May 15.
Advances in medical care have led to more premature babies surviving the neonatal period. In these babies, germinal matrix haemorrhage (GMH), intraventricular haemorrhage (IVH) and posthaemorrhagic ventricular dilatation (PHVD) are the most important determinants of long-term cognitive and developmental outcomes. In this review, we discuss current neurosurgical management of IVH and PHVD, including the importance of early diagnosis of PHVD, thresholds for intervention, options for early management through the use of temporising measures and subsequent definitive CSF diversion. We also discuss treatment options for the evolving paradigm to manage intraventricular blood and its breakdown products. We review the evidence for techniques such as drainage, irrigation, fibrinolytic therapy (DRIFT) and neuroendoscopic lavage in the context of optimising cognitive, neurodevelopmental and quality of life outcomes in these premature infants.
医疗技术的进步使得更多早产儿能够在新生儿期存活下来。在这些早产儿中，生发基质出血（GMH）、脑室内出血（IVH）和出血后脑室扩张（PHVD）是长期认知和发育结果的最重要决定因素。在这篇综述中，我们讨论了目前针对 IVH 和 PHVD 的神经外科学治疗方法，包括早期诊断 PHVD 的重要性、干预的阈值、通过使用临时措施进行早期管理的选择，以及随后进行确定性 CSF 引流的选择。我们还讨论了治疗不断变化的脑室内血液及其分解产物的方法。我们回顾了在优化这些早产儿的认知、神经发育和生活质量结果方面，引流、冲洗、纤溶治疗（DRIFT）和神经内镜灌洗等技术的证据。
