Hudgins R J, Boydston W R, Gilreath C L
Department of Neurosurgery, Scottish Rite Children's Medical Center, Atlanta, Ga., USA.
Pediatr Neurosurg. 1998 Dec;29(6):309-13. doi: 10.1159/000028744.
Intraventricular hemorrhage (IVH) and subsequent posthemorrhagic hydrocephalus (PHH) commonly complicate the course of extremely preterm infants. Many methods for treating the hydrocephalus have been used, none of which are ideal. We present the largest series of infants with PHH treated with one modality, the ventricular access device (VAD). One hundred and forty-nine preterm infants with PHH were treated by placement of a VAD and serial taps to control intracranial pressure and ventricular size. Variables recorded include gender, race, gestational age, weight at birth, IVH grade, incidence of VAD infection, malfunction or local wound problems and indwelling time to either shunt placement or VAD removal. Of the 149 preterm infants, 91 were males and 58 females. The average birth weight was 994 g and the average gestational age at birth was 26.3 weeks. Three infants were IVH grade 1, 8 were grade 2, 62 were grade 3 and 76 were grade 4. VAD occlusion occurred in 15 infants (10%). Nine infants required contralateral VAD placement for a trapped ventricle. VAD infection occurred in 12 infants (8%), 5 of whom were treated successfully with a combination of systemic and intra-VAD antibiotics without removal of the VAD. The total rate of revision was thus 20% (15 for occlusion, 9 for trapped ventricle, 7 for infection). Wound problems were minimal and consisted of 4 cerebrospinal fluid leaks and 14 subgaleal fluid collections. For the 133 survivors, the rate of shunt placement was 88%. The VAD, while not ideal, is an excellent treatment at this time for PHH. It can be utilized for several months with acceptable rates of infection, blockage and wound complications. The VAD tap is simple to perform, not disruptive to minimal stimulation protocols, and can be done by physician extenders. In addition, medications can be administered via the access device, thus allowing treatment of some infections without VAD removal as well as instillation of thrombolytic agents such as urokinase.
脑室内出血（IVH）及随后的出血后脑积水（PHH）是极早产儿病程中常见的并发症。治疗脑积水的方法众多，但均不尽人意。我们报告了采用单一治疗方式——脑室引流装置（VAD）治疗的最大规模PHH婴儿系列病例。149例患有PHH的早产儿接受了VAD置入及系列穿刺以控制颅内压和脑室大小。记录的变量包括性别、种族、胎龄、出生体重、IVH分级、VAD感染、故障或局部伤口问题的发生率以及至分流置入或VAD移除的留置时间。149例早产儿中，男性91例，女性58例。平均出生体重为994g，平均出生胎龄为26.3周。3例婴儿为IVH 1级，8例为2级，62例为3级，76例为4级。15例婴儿（10%）出现VAD堵塞。9例婴儿因脑室受压需要对侧VAD置入。12例婴儿（8%）发生VAD感染，其中5例通过全身及VAD内联合使用抗生素成功治疗，未移除VAD。因此，总的翻修率为20%（堵塞15例，脑室受压9例，感染7例）。伤口问题极少，包括4例脑脊液漏和14例帽状腱膜下积液。133例存活者中，分流置入率为88%。VAD虽不理想，但目前是治疗PHH的一种有效方法。它可使用数月，感染、堵塞及伤口并发症发生率均可接受。VAD穿刺操作简单，不干扰最小刺激方案，且可由医生助理完成。此外，药物可通过引流装置给药，从而在不移除VAD的情况下治疗某些感染，并可注入溶栓剂如尿激酶。
