{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:07:59Z","timestamp":1787836079019,"version":"build-2784847793"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2019,9,10]],"date-time":"2019-09-10T00:00:00Z","timestamp":1568073600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2019,9,10]],"date-time":"2019-09-10T00:00:00Z","timestamp":1568073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006209","name":"Radboud University Medical Center","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006209","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Childs Nerv Syst"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n              <jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Posthaemorrhagic ventricular dilatation in preterm infants is primarily treated using temporising measures, of which the placement of a ventricular access device (VAD) is one option. Permanent shunt dependency rates are high, though vary widely. In order to improve the treatment burden and lower shunt dependency rates, we implemented several changes over the years. One of these changes involves the setting of the surgery from general anaesthesia in the OR to local anaesthesia in bed at the neonatal intensive care unit (NICU), which may seem counterintuitive to many. In this article, we describe our surgical technique and present the results of this regimen and compare it to our previous techniques.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Retrospective study of a consecutive series of 37 neonates with posthaemorrhagic ventricular dilatation (PHVD) treated using a VAD, with a cohort I (<jats:italic>n<\/jats:italic>\u2009=\u200913) treated from 2004 to 2008 under general anaesthesia in the OR, cohort II (<jats:italic>n<\/jats:italic>\u2009=\u200911) treated from 2009 to 2013 under general anaesthesia in the NICU and cohort III (<jats:italic>n<\/jats:italic>\u2009=\u200913) treated from December 2013 to December 2017 under local anaesthesia on the NICU.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The overall infection rate was 14%; the VAD revision rate was 22% and did not differ significantly between the cohorts. Procedures under local anaesthesia never required conversion to general anaesthesia and were well tolerated. After an average of 33 tapping days, 38% of the neonates received a permanent ventriculoperitoneal (VP) shunt. The permanent VP shunt rate was 9% with VAD placement under local anaesthesia and 52% when performed under general anaesthesia (<jats:italic>p<\/jats:italic>\u2009=\u20090.02).<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Bedside placement of VADs for PHVD under local anaesthesia in neonates is a low-risk, well-tolerated procedure that results in at least equal results to surgery performed under general anaesthesia and\/or performed in an OR.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00381-019-04361-3","type":"journal-article","created":{"date-parts":[[2019,9,10]],"date-time":"2019-09-10T08:05:57Z","timestamp":1568102757000},"page":"2307-2312","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Bedside placement of ventricular access devices under local anaesthesia in neonates with posthaemorrhagic hydrocephalus: preliminary experience"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8609-2521","authenticated-orcid":false,"given":"Erik J.","family":"van Lindert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. Djien","family":"Liem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Geerlings","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Delye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,9,10]]},"reference":[{"key":"4361_CR1","doi-asserted-by":"publisher","first-page":"61","DOI":"10.3171\/2018.1.PEDS17537","volume":"22","author":"HC Bock","year":"2018","unstructured":"Bock HC, Feldmann J, Ludwig HC (2018) Early surgical management and long-term surgical outcome for intraventricular hemorrhage-related posthemorrhagic hydrocephalus in shunt-treated premature infants. J Neurosurg Pediatr 22:61\u201367. \nhttps:\/\/doi.org\/10.3171\/2018.1.PEDS17537","journal-title":"J Neurosurg Pediatr"},{"key":"4361_CR2","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1016\/j.jpeds.2007.10.005","volume":"152","author":"A Brouwer","year":"2008","unstructured":"Brouwer A, Groenendaal F, van Haastert IL, Rademaker K, Hanlo P, de Vries L (2008) Neurodevelopmental outcome of preterm infants with severe intraventricular hemorrhage and therapy for post-hemorrhagic ventricular dilatation. J Pediatr 152:648\u2013654. \nhttps:\/\/doi.org\/10.1016\/j.jpeds.2007.10.005","journal-title":"J Pediatr"},{"key":"4361_CR3","doi-asserted-by":"publisher","first-page":"F50","DOI":"10.1136\/adc.2010.207837","volume":"97","author":"AJ Brouwer","year":"2012","unstructured":"Brouwer AJ, Brouwer MJ, Groenendaal F, Benders MJ, Whitelaw A, de Vries LS (2012) European perspective on the diagnosis and treatment of posthaemorrhagic ventricular dilatation. Arch Dis Child Fetal Neonatal Ed 97:F50\u2013F55. \nhttps:\/\/doi.org\/10.1136\/adc.2010.207837","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"4361_CR4","doi-asserted-by":"publisher","first-page":"e217","DOI":"10.1016\/j.wneu.2018.04.169","volume":"116","author":"C d\u2019Arcangues","year":"2018","unstructured":"d\u2019Arcangues C, Schulz M, Buhrer C, Thome U, Krause M, Thomale UW (2018) Extended experience with neuroendoscopic lavage for posthemorrhagic hydrocephalus in neonates. World Neurosurg 116:e217\u2013e224. \nhttps:\/\/doi.org\/10.1016\/j.wneu.2018.04.169","journal-title":"World Neurosurg"},{"key":"4361_CR5","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1111\/j.1651-2227.2002.tb01697.x","volume":"91","author":"LS de Vries","year":"2002","unstructured":"de Vries LS, Liem KD, van Dijk K, Smit BJ, Sie L, Rademaker KJ, Gavilanes AW, Dutch Working Group of Neonatal N (2002) Early versus late treatment of posthaemorrhagic ventricular dilatation: results of a retrospective study from five neonatal intensive care units in The Netherlands. Acta Paediatr 91:212\u2013217","journal-title":"Acta Paediatr"},{"key":"4361_CR6","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1007\/s00381-018-3894-7","volume":"34","author":"C Gaderer","year":"2018","unstructured":"Gaderer C, Schaumann A, Schulz M, Thomale UW (2018) Neuroendoscopic lavage for the treatment of CSF infection with hydrocephalus in children. Childs Nerv Syst 34:1893\u20131903. \nhttps:\/\/doi.org\/10.1007\/s00381-018-3894-7","journal-title":"Childs Nerv Syst"},{"key":"4361_CR7","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1007\/s00268-014-2895-2","volume":"39","author":"L Hagander","year":"2015","unstructured":"Hagander L, Kabir M, Chowdhury MZ, Gunnarsdottir A, Habib MG, Banu T (2015) Major neonatal surgery under local anesthesia: a cohort study from Bangladesh. World J Surg 39:953\u2013960. \nhttps:\/\/doi.org\/10.1007\/s00268-014-2895-2","journal-title":"World J Surg"},{"key":"4361_CR8","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1007\/s00381-011-1413-1","volume":"27","author":"E Januschek","year":"2011","unstructured":"Januschek E, Machado LS, Steinthal B, Ulrich PT (2011) Posthemorrhagic hydrocephalus in very low birth weight infants--a new gentle surgical technique for external ventricular drainage. Childs Nerv Syst 27:991\u2013994. \nhttps:\/\/doi.org\/10.1007\/s00381-011-1413-1","journal-title":"Childs Nerv Syst"},{"key":"4361_CR9","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1136\/adc.56.12.900","volume":"56","author":"MI Levene","year":"1981","unstructured":"Levene MI (1981) Measurement of the growth of the lateral ventricles in preterm infants with real-time ultrasound. Arch Dis Child 56:900\u2013904","journal-title":"Arch Dis Child"},{"key":"4361_CR10","doi-asserted-by":"publisher","first-page":"224","DOI":"10.3171\/2010.5.PEDS1010","volume":"6","author":"DD Limbrick Jr","year":"2010","unstructured":"Limbrick DD Jr, Mathur A, Johnston JM, Munro R, Sagar J, Inder T, Park TS, Leonard JL, Smyth MD (2010) Neurosurgical treatment of progressive posthemorrhagic ventricular dilation in preterm infants: a 10-year single-institution study. J Neurosurg Pediatr 6:224\u2013230. \nhttps:\/\/doi.org\/10.3171\/2010.5.PEDS1010","journal-title":"J Neurosurg Pediatr"},{"key":"4361_CR11","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1055\/s-0032-1320023","volume":"74","author":"UM Mauer","year":"2013","unstructured":"Mauer UM, Unterreithmeir L, Jahn A, Wagner W, Kunz U, Schulz C (2013) A survey on current practice in the neurosurgical management of preterm infants with posthemorrhagic hydrocephalus in Germany. J Neurol Surg A Cent Eur Neurosurg 74:82\u201386. \nhttps:\/\/doi.org\/10.1055\/s-0032-1320023","journal-title":"J Neurol Surg A Cent Eur Neurosurg"},{"issue":"Suppl 1","key":"4361_CR12","doi-asserted-by":"publisher","first-page":"8","DOI":"10.3171\/2014.7.PEDS14322","volume":"14","author":"CA Mazzola","year":"2014","unstructured":"Mazzola CA, Choudhri AF, Auguste KI, Limbrick DD Jr, Rogido M, Mitchell L, Flannery AM, Pediatric Hydrocephalus Systematic R, Evidence-Based Guidelines Task F (2014) Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants. J Neurosurg Pediatr 14(Suppl 1):8\u201323. \nhttps:\/\/doi.org\/10.3171\/2014.7.PEDS14322","journal-title":"J Neurosurg Pediatr"},{"key":"4361_CR13","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1007\/s003810000418","volume":"17","author":"E Richard","year":"2001","unstructured":"Richard E, Cinalli G, Assis D, Pierre-Kahn A, Lacaze-Masmonteil T (2001) Treatment of post-haemorrhage ventricular dilatation with an Ommaya\u2019s reservoir: management and outcome of 64 preterm infants. Childs Nerv Syst 17:334\u2013340","journal-title":"Childs Nerv Syst"},{"key":"4361_CR14","doi-asserted-by":"publisher","first-page":"473","DOI":"10.3171\/2012.1.PEDS11292","volume":"9","author":"J Riva-Cambrin","year":"2012","unstructured":"Riva-Cambrin J, Shannon CN, Holubkov R, Whitehead WE, Kulkarni AV, Drake J, Simon TD, Browd SR, Kestle JR, Wellons JC 3rd, Hydrocephalus Clinical Research N (2012) Center effect and other factors influencing temporization and shunting of cerebrospinal fluid in preterm infants with intraventricular hemorrhage. J Neurosurg Pediatr 9:473\u2013481. \nhttps:\/\/doi.org\/10.3171\/2012.1.PEDS11292","journal-title":"J Neurosurg Pediatr"},{"key":"4361_CR15","doi-asserted-by":"publisher","first-page":"242","DOI":"10.3171\/2011.12.PEDS11136","volume":"9","author":"S Robinson","year":"2012","unstructured":"Robinson S (2012) Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts. J Neurosurg Pediatr 9:242\u2013258. \nhttps:\/\/doi.org\/10.3171\/2011.12.PEDS11136","journal-title":"J Neurosurg Pediatr"},{"key":"4361_CR16","doi-asserted-by":"publisher","first-page":"156","DOI":"10.3171\/2014.9.PEDS14215","volume":"15","author":"HS Spader","year":"2015","unstructured":"Spader HS, Hertzler DA, Kestle JR, Riva-Cambrin J (2015) Risk factors for infection and the effect of an institutional shunt protocol on the incidence of ventricular access device infections in preterm infants. J Neurosurg Pediatr 15:156\u2013160. \nhttps:\/\/doi.org\/10.3171\/2014.9.PEDS14215","journal-title":"J Neurosurg Pediatr"},{"key":"4361_CR17","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1159\/000337876","volume":"48","author":"AG Tian","year":"2012","unstructured":"Tian AG, Hintz SR, Cohen RS, Edwards MS (2012) Ventricular access devices are safe and effective in the treatment of posthemorrhagic ventricular dilatation prior to shunt placement. Pediatr Neurosurg 48:13\u201320. \nhttps:\/\/doi.org\/10.1159\/000337876","journal-title":"Pediatr Neurosurg"},{"key":"4361_CR18","doi-asserted-by":"publisher","first-page":"e0190249","DOI":"10.1371\/journal.pone.0190249","volume":"13","author":"EJ van Lindert","year":"2018","unstructured":"van Lindert EJ, Bilsen MV, Flier MV, Kolwijck E, Delye H, Oever JT (2018) Topical vancomycin reduces the cerebrospinal fluid shunt infection rate: a retrospective cohort study. PLoS One 13:e0190249. \nhttps:\/\/doi.org\/10.1371\/journal.pone.0190249","journal-title":"PLoS One"},{"key":"4361_CR19","doi-asserted-by":"publisher","first-page":"447","DOI":"10.3171\/2014.7.PEDS13552","volume":"14","author":"JY Wang","year":"2014","unstructured":"Wang JY, Amin AG, Jallo GI, Ahn ES (2014) Ventricular reservoir versus ventriculosubgaleal shunt for posthemorrhagic hydrocephalus in preterm infants: infection risks and ventriculoperitoneal shunt rate. J Neurosurg Pediatr 14:447\u2013454. \nhttps:\/\/doi.org\/10.3171\/2014.7.PEDS13552","journal-title":"J Neurosurg Pediatr"},{"key":"4361_CR20","doi-asserted-by":"publisher","first-page":"19","DOI":"10.3171\/2017.1.PEDS16496","volume":"20","author":"JC Wellons 3rd","year":"2017","unstructured":"Wellons JC 3rd, Shannon CN, Holubkov R, Riva-Cambrin J, Kulkarni AV, Limbrick DD Jr, Whitehead W, Browd S, Rozzelle C, Simon TD, Tamber MS, Oakes WJ, Drake J, Luerssen TG, Kestle J, Hydrocephalus Clinical Research N (2017) Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study. J Neurosurg Pediatr 20:19\u201329. \nhttps:\/\/doi.org\/10.3171\/2017.1.PEDS16496","journal-title":"J Neurosurg Pediatr"},{"key":"4361_CR21","doi-asserted-by":"publisher","first-page":"50","DOI":"10.3171\/2009.2.PEDS08400","volume":"4","author":"JC Wellons","year":"2009","unstructured":"Wellons JC, Shannon CN, Kulkarni AV, Simon TD, Riva-Cambrin J, Whitehead WE, Oakes WJ, Drake JM, Luerssen TG, Walker ML, Kestle JR, Hydrocephalus Clinical Research N (2009) A multicenter retrospective comparison of conversion from temporary to permanent cerebrospinal fluid diversion in very low birth weight infants with posthemorrhagic hydrocephalus. J Neurosurg Pediatr 4:50\u201355. \nhttps:\/\/doi.org\/10.3171\/2009.2.PEDS08400","journal-title":"J Neurosurg Pediatr"},{"key":"4361_CR22","doi-asserted-by":"publisher","first-page":"e1071","DOI":"10.1542\/peds.2006-2841","volume":"119","author":"A Whitelaw","year":"2007","unstructured":"Whitelaw A, Evans D, Carter M, Thoresen M, Wroblewska J, Mandera M, Swietlinski J, Simpson J, Hajivassiliou C, Hunt LP, Pople I (2007) Randomized clinical trial of prevention of hydrocephalus after intraventricular hemorrhage in preterm infants: brain-washing versus tapping fluid. Pediatrics 119:e1071\u2013e1078. \nhttps:\/\/doi.org\/10.1542\/peds.2006-2841","journal-title":"Pediatrics"},{"key":"4361_CR23","doi-asserted-by":"publisher","first-page":"e852","DOI":"10.1542\/peds.2009-1960","volume":"125","author":"A Whitelaw","year":"2010","unstructured":"Whitelaw A, Jary S, Kmita G, Wroblewska J, Musialik-Swietlinska E, Mandera M, Hunt L, Carter M, Pople I (2010) Randomized trial of drainage, irrigation and fibrinolytic therapy for premature infants with posthemorrhagic ventricular dilatation: developmental outcome at 2 years. Pediatrics 125:e852\u2013e858. \nhttps:\/\/doi.org\/10.1542\/peds.2009-1960","journal-title":"Pediatrics"},{"key":"4361_CR24","doi-asserted-by":"publisher","first-page":"94","DOI":"10.3171\/2008.11.PEDS0827","volume":"3","author":"B Willis","year":"2009","unstructured":"Willis B, Javalkar V, Vannemreddy P, Caldito G, Matsuyama J, Guthikonda B, Bollam P, Nanda A (2009) Ventricular reservoirs and ventriculoperitoneal shunts for premature infants with posthemorrhagic hydrocephalus: an institutional experience. J Neurosurg Pediatr 3:94\u2013100. \nhttps:\/\/doi.org\/10.3171\/2008.11.PEDS0827","journal-title":"J Neurosurg Pediatr"},{"key":"4361_CR25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/2016.1.PEDS15563","volume":"18","author":"M Zucchelli","year":"2016","unstructured":"Zucchelli M, Lefosse M, Corvaglia L, Martini S, Sandri F, Soffritti S, Ancora G, Mammoliti P, Gargano G, Galassi E (2016) Introduction of percutaneous-tunneled transfontanellar external ventricular drainage in the management of hydrocephalus in extremely low-birth-weight infants. J Neurosurg Pediatr 18:1\u20136. \nhttps:\/\/doi.org\/10.3171\/2016.1.PEDS15563","journal-title":"J Neurosurg Pediatr"}],"container-title":["Child's Nervous System"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00381-019-04361-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00381-019-04361-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00381-019-04361-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T09:41:20Z","timestamp":1599730880000},"score":1,"resource":{"primary":{"URL":"http:\/\/link.springer.com\/10.1007\/s00381-019-04361-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9,10]]},"references-count":25,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["4361"],"URL":"https:\/\/doi.org\/10.1007\/s00381-019-04361-3","relation":{},"ISSN":["0256-7040","1433-0350"],"issn-type":[{"value":"0256-7040","type":"print"},{"value":"1433-0350","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9,10]]},"assertion":[{"value":"5 December 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 August 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 September 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The work described has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans. The study has been approved by the institutional review board CMO Arnhem-Nijmegen (IRB). The IRB waived informed consent due to the nature of the investigations.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}