Roy Priyanka, Lo Marcus, Tessier David, Kishimoto Jessica, Bhattacharya Soume, Eagleson Roy, Fenster Aaron, Ribaupierre Sandrine de
Departments of1Medical Biophysics.
2Robarts Research Institute, University of Western Ontario, London; and.
J Neurosurg Pediatr. 2023 Jan 20;31(4):321-328. doi: 10.3171/2022.12.PEDS22303. Print 2023 Apr 1.
Some neonates born prematurely with intraventricular hemorrhage develop posthemorrhagic hydrocephalus and require lifelong treatment to divert the flow of CSF. Early prediction of the eventual need for a ventriculoperitoneal shunt (VPS) is difficult, and early discussions with families are based on statistics and the grade of hemorrhage. The authors hypothesize that change in ventricular volume during ventricular taps that is measured with repeated 3D ultrasound (3D US) imaging of the lateral ventricles could be used to assess the risk of the future requirement of a VPS.
A total of 92 neonates with intraventricular hemorrhage who were treated in the NICU were recruited between April 2012 and November 2019. Only patients who required ventricular taps (VTs) were included in this study, resulting in the analysis of 19 patients with a total of 61 VTs. Among them, 14 patients were treated with a VPS, and in 5 patients the hydrocephalus resolved spontaneously. Parameters studied were total ventricular volume measured with 3D US, ventricular volume change after VT, the ratio between volume reduction and tap amount, the difference between tap amount and volume reduction after tap, the average tap amount, the average number of days between taps, pre-tap head circumference, and reduction in head circumference after tap.
Statistically significant differences were found in ventricular volume reduction after tap (p = 0.007), the ratio between volume reduction and tap amount (p = 0.03), the difference between tap amount and volume reduction after tap (p = 0.05), and the interval of days between taps (p = 0.0115).
Measuring with 3D US before and after VT can be a useful tool for quantifying ventricular volume. The findings in this study showed that neonates who experience a large reduction of ventricular volume after VT are more likely to be treated with a shunt than are neonates who experience a small reduction.
一些早产且伴有脑室内出血的新生儿会发展为出血后脑积水，需要终身治疗以改变脑脊液的流动。早期预测最终是否需要脑室腹腔分流术（VPS）很困难，与家属的早期讨论基于统计数据和出血分级。作者推测，通过对侧脑室进行重复三维超声（3D US）成像测量脑室穿刺期间脑室体积的变化，可用于评估未来需要VPS的风险。
2012年4月至2019年11月期间，共招募了92例在新生儿重症监护病房接受治疗的脑室内出血新生儿。本研究仅纳入需要进行脑室穿刺（VT）的患者，对19例患者的61次VT进行了分析。其中，14例患者接受了VPS治疗，5例患者的脑积水自行消退。研究的参数包括用3D US测量的脑室总体积、VT后的脑室体积变化、体积减少与穿刺量的比值、穿刺量与穿刺后体积减少的差值、平均穿刺量、穿刺间隔的平均天数、穿刺前头围以及穿刺后头围的减少量。
在穿刺后脑室体积减少（p = 0.007）、体积减少与穿刺量的比值（p = 0.03）、穿刺量与穿刺后体积减少的差值（p = 0.05）以及穿刺间隔天数（p = 0.0115）方面发现了统计学上的显著差异。
VT前后用3D US测量可成为量化脑室体积的有用工具。本研究结果表明，与脑室体积减少较小的新生儿相比，VT后脑室体积大幅减少的新生儿更有可能接受分流治疗。
