Cerebrospinal fluid drainage in posthemorrhagic ventricular dilatation and its effects on cerebral hemodynamics

INTRODUCTION: Posthemorrhagic ventricular dilatation (PHVD) is an important complication of intraventricular hemorrhage in preterm neonates. The definitive treatment of PHVD is ventriculoperitoneal shunt application, but being over 2500 g is expected for the operation, and there is still debate on the choice and timing of temporizing interventions until shunt application. In this prospective study, we aimed to observe the effects of ventricular decompression via lumbar puncture or reservoir on cerebral hemodynamics, ventricular measurements, and head circumference.
METHODS: A total of 19 cerebrospinal fluid drainage applications in 10 patients ≤34 weeks gestation with PHVD was included. Ventricular size and medial cerebral artery Doppler measurements in ultrasonography, cerebral tissue oxygenation using near infrared spectroscopy, and head circumference of the patients who required ventricular decompression were recorded 1 h before and 2 h after interventions.
RESULTS: Ventricular measurements significantly decreased after intervention. Ventricular dilatation (ventricular index right/left and anterior horn width left/right: p=0.001/p=0.02 and p<0.001/p=0.003, respectively), Doppler measurements (resistivity index: p<0.001, pulsatiliy index: p<0.001), and cerebral tissue oxygenation (cerebral tissue oxygen saturation: p<0,001, fractioned oxygen extraction: p<0.001) significantly improved after intervention. No change in head circumference was observed 2 h and 24 h after decompression (p=0.46 and p=0.571, respectively).
DISCUSSION AND CONCLUSION: In infants with PHVD, the ventricular enlargement is accompanied by hemodynamic disturbance, which can be corrected with decompression. Doppler studies and ventricular measurements may be considered as “alarming” parameters for ventricular decompression and may contribute to protection of rapidly growing and delicate premature brain from the negative effects of the increased cerebral pressure.