Stage-by-stage treatment of hydrocephalus in premature infants

Background . The issues of treatment of posthemorrhagic hydrocephalus (PHH) in premature infants, aimed to eliminate disorders of cerebrospinal fluid (CSF) dynamics, remain relevant. Aim . Improving the PHH treatment in premature infants. Materials and methods . The analysis of the treatment of 350 premature infants with PHH for the period 2000–2023 (Crimea). Two groups are allocated: in 194 children (group 1), standard step-by-step treatment was performed, including lumbar punctures, ventricular-subgaleal drainage and ventricular-peritoneal shunting; in 156 children (group 2), the treatment included the option of coronary-translambdoid subarachno-ventriculostomy at the initial stage of the PHH (Patent No. RU2715535C1) and ventricular-subarachnoid stenting with the progression of PHH (Patent No. RU2721455C1). Results . It is noted that the dynamics of the formation of PHH is due to a complex of pathological factors in the acute (7 days), subacute (up to 3 weeks) and chronic period (after 3 weeks) after intracranial hemorrhages. In the acute and subacute period, with a high risk of recurrent hemorrhages, primary disorders of CSF dynamics with occlusive PHH, in the chronic period secondary disorders of CSF dynamics with progressive absorption disorder. The inclusion of the options of coronary-translambdoid subarachno-ventriculostomy and ventricular-subarachnoid stenting in the standard protocol allowed to expand the pathogenic treatment at the stages of formation of primary and secondary disorders of CSF dynamics. There is a reduction in the time of rehabilitation of the CSF from the blood with coronary-translambdoid subarachno-ventriculostomy + lumbar punctures up to 2 weeks, recovery of outflow and absorption of CSF with ventricular-subarachnoid stenting + ventricular-subgaleal drainage + lumbar punctures up to 6 weeks after surgery with PHH compensation in 73,7 % (p<0.001). Conclusion . The obtained result allows us to consider the effectiveness of including the proposed options in a modern treatment algorithm for PHH in premature infants. The terms of hospitalization and number of complications reduced, the results of treatment are improved.