Management of posthaemorrhagic hydrocephalus with a subcutaneous ventricular catheter reservoir in premature infants.

A subcutaneous ventricular catheter reservoir was inserted in 13 premature infants for the treatment of posthaemorrhagic hydrocephalus. Criteria for insertion of the reservoir were: increase in head circumference of more than 1 cm per week, progressive ventricular dilatation on ultrasound scans, failure to control posthaemorrhagic hydrocephalus by lumbar punctures, severe deterioration during lumbar punctures. Tapping of the reservoir one to four times a day for 6 to 90 (median 40) days was guided by clinical criteria (head circumference, ventricle size on ultrasound scans, tension of the fontanelle, position of the cranial sutures). Treatment was effective in all patients as judged by clinical criteria. In five patients, intracranial pressure was measured through the reservoir on 47 occasions before and after aspiration of cerebrospinal fluid. In four of these patients, the course of the intracranial pressure corresponded to the course of the clinical criteria. In one patient, however, intracranial pressure was raised despite normal clinical signs. Thus, clinical signs for guidance of the treatment are not sufficient in some patients, but should be completed by measurements of intracranial pressure through the reservoir. As peaks of intracranial pressure between the taps cannot be ruled out, continuous monitoring of intracranial pressure could probably further increase the efficacy of the treatment. No serious complications were observed except skin break down in one patient. In particular, there was neither a leak from the reservoir, nor obstruction of the ventricular catheter, nor did any infection occur despite frequent aspirations. In conclusion, the use of a ventricular catheter reservoir is an effective and safe method for longterm treatment of posthaemorrhagic hydrocephalus in premature infants until an indwelling cerebrospinal fluid diversion system can be inserted. (Arch Dis Child 64: 24–28, 1989)