Current methods in the treatment of posthemorrhagic hydrocephalus in infants.

The authors reviewed the most recent methods and approaches in the management of posthemorrhagic hydrocephalus in infants. Posthemorrhagic hydrocephalus in infants is associated with a high mortality and morbidity. The incidence of developmental delay, cerebral palsy, epilepsy end visual impairment in surviving children is variable. All treatments have significant drawbacks. Repeated lumbar punctures are frequently associated with high rate of infection and the amount of cerebrospinal fluid drained may be insufficient. External ventricular drainage appears to be more effective than lumbar punctures in evacuating sufficient volumes of cerebrospinal fluid. With subcutaneous reservoir the withdrawal of a sufficient volume of cerebrospinal fluid is achieved, but intermittent elevations of intracranial pressure still occur. Intraventricular fibrinolytic therapy is a promising method in the management of posthemorrhagic hydrocephalus, however more studies with larger numbers of patients are needed. The most common treatment of posthemorrhagic hydrocephalus involves permanent ventricular shunting. Shunts with a programmable valve seem to be superior to other shunt systems. In case of compartmentalization endoscopic procedures are preferred. Conservative treatment with acetazolamide and furosemide does not seem to confer any advantage to the management of posthemorragic hydrocephalus. (Tab. 2, Fig. 2, Ref. 26.)