Turkish Neurosurgery

A two-step therapeutic strategy in the management of critical neonatal hydrocephalus

Qian Ouyang¹, Junqiang Wang², Yijian Yang², Kaiyue Wang², Yexin Yuan², Maolin He¹, Zhijun Zhong⁷, Gelei Xiao²

¹The First Affiliated Hospital of Guangxi Medical University, Division of Spinal Surgery, Nanning,
²Xiangya Hospital, Central South University, Department of Neurosurgery, Changsha,
³The Affiliated Zhuzhou Hospital Xiangya Medical College, Department of Neurosurgery, Zhuzhou,
⁴Xiangya Hospital, Central South University, Diagnosis and Treatment Center for Hydrocephalus, Changsha,
⁵Xiangya Hospital, Central South University, Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Changsha,
⁶Xiangya Hospital, Central South University, National Clinical Research Center for Geriatric Disorders, Changsha,
⁷Changsha Hospital of Traditional Chinese Medicine (Changsha Eighth Hospital), Department of Neurosurgery, Changsha,

DOI: 10.5137/1019-5149.JTN.47201-24.1

Aim:Currently, treatment outcomes for critical neonatal hydrocephalus remain poor. We are committed to exploring a new therapeutic process with which to improve the outcome of neonatal hydrocephalus.Material and Methods:In this paper, we reviewed and analyzed the experience of treating neonatal hydrocephalus in our hospital during the nine years from 1 February 2015 to 1 February 2024. We hope to provide valuable lessons and assistance to treat future patients with critical neonatal hydrocephalus through literature searches and summarizing our relevant treatment strategies.Results:In the study, 64 neonatal patients were included. The breakdown of hydrocephalus cases by cause was as follows: 59.1% due to cerebral hemorrhage, 24.0% due to intracranial infection, and 16.9% due to other causes. Additionally, 32.8% of the patients had ultra-low birth weight (ULBW), 14.1% had very low birth weight (VLBW), and 53.1% had low birth weight (LBW). Preterm babies comprised 84.3% of the patients, while term babies comprised 15.7%. Additionally, all the treatments for patients involved surgery, with 3.06% undergoing endoscopic third ventriculostomy (ETV), 29.59% undergoing ventriculoperitoneal shunt (VPS), 32.65% undergoing Extra ventricular drainage (EVD), 1.53% undergoing ventriculoatrial shunt (VAS), and 20.41% undergoing Ommaya reservoir. Finally, a process of surgical treatment of hydrocephalus in intensive neonatal hydrocephalus is proposed. First, we try to get the patient to the proper physical status (weight and corrected gestational age achieved) and to control intracranial infection or bleeding. Secondly, a permanent shunt is performed once the patient meets the surgical criteria.Conclusion:A two-step treatment strategy for the surgical management of critical neonatal hydrocephalus is proposed. Moreover, we have clarified the detailed criteria for each step of the treatment plan to promote a higher success rate in saving children\'s lives. The prognosis for critical neonatal hydrocephalus is favorable if treated appropriately.

Corresponding author : Gelei Xiao