ISOLATED VENTRICLES AFTER IVH

Abstract

Post hemorrhagic hydrocephalus (PHH) frequently occurs after large neonatal IVH. Previous experience has documented the difficulty in controlling progressive ventricular dilatation soon after the hemorrhage, necessitating trials of multiple medical (glycerol, diamox, LP, etc) and surgical (extraventricular drainage, ventricular reservoir, etc) therapies. Our experience indicates that PHH continues to pose difficulties in management even after a definitive ventriculoperitoneal shunt (VPS) has been accomplished. Five babies required VPS for PHH during a 12 month period, 3 after grade III and 2 after grade 4 IVH. All babies were treated with serial LP and 3 were treated with a ventricular reservoir prior to VPS. During the first 6 months after VPS, 3 babies required the insertion of additional VPS for isolated ventricles. One infant required bilateral lateral ventricle VPS because of isolation of a lateral ventricle, one required insertion of a posterior fossa shunt to treat an isolated 4th ventricle, and one infant required bilateral lateral ventricle shunts and a posterior fossa shunt because of isolation of the 4th ventricle and a temporal horn. Despite progressive dilatation of the isolated ventricle, neither accelerated head growth nor signs of increased intracranial pressure were seen. Symptoms were subtle initially, consisting only of vague irritability and inattention. The frequency of isolated ventricles in PHH demands that these infants be carefully watched even after VPS. The paucity of signs and symptoms requires frequent CT or ultrasound even if the clinical condition seems stable.

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