{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:08:02Z","timestamp":1787836082614,"version":"build-2784847793"},"reference-count":21,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Hydrocephalus treatment in extremely low-birth-weight (ELBW) infants still represents a challenge for the pediatric neurosurgeon, particularly when the patient weighs far less than 1000 g. In such cases, the benefits in terms of neurological outcome following early treatment do not always outweigh the surgical risks, especially considering the great difference in the surgical risk before patient weight increases. To assess the efficacy and reliability of a percutaneous-tunneled, transfontanellar external ventricular drain (PTTEVD) in ELBW infants, the authors started a new protocol for the early surgical treatment of hydrocephalus.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Ten cases of posthemorrhagic hydrocephalus (PHH) in ELBW infants (5 cases &lt; 700 g, range for all cases 550\u20131000 g) were treated with a PTTEVD that was implanted at bedside as the first measure in a stepwise approach.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The average duration of the procedure was 7 minutes, and there was no blood loss. The drain remained in place for an average of 24 days (range 8\u201345 days). In all cases early control of the hydrocephalus was achieved. One patient had a single episode of CSF leakage (due to insufficient CSF removal). In another patient <jats:italic>Enterococcus<\/jats:italic> in the CSF sample was detected the day after abdominal surgery with ileostomy (infection resolved with intrathecal vancomycin). One patient died of <jats:italic>Streptococcus<\/jats:italic> sepsis, a systemic infection existing prior to drain placement that never resolved. One patient had <jats:italic>Pseudomonas aeruginosa<\/jats:italic> sepsis prior to drain insertion; a PTTEVD was implanted, the infection resolved, and the hydrocephalus was treated in the same way as with a traditional EVD, while the advantages of a quick, minimally invasive, bedside procedure were maintained. Once a patient reached 1 kg in weight, when necessary, a ventriculoperitoneal shunt was implanted and the PTTEVD was removed.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The introduction of PTTEVD placement in our standard protocol for the management of PHH has proved to be a wise option for small patients.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.1.peds15563","type":"journal-article","created":{"date-parts":[[2016,3,25]],"date-time":"2016-03-25T13:57:59Z","timestamp":1458914279000},"page":"1-6","source":"Crossref","is-referenced-by-count":12,"title":["Introduction of percutaneous-tunneled transfontanellar external ventricular drainage in the management of hydrocephalus in extremely low-birth-weight infants"],"prefix":"10.3171","volume":"18","author":[{"given":"Mino","family":"Zucchelli","sequence":"first","affiliation":[{"name":"Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariella","family":"Lefosse","sequence":"additional","affiliation":[{"name":"Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Corvaglia","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Martini","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Sandri","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Maternal and Pediatrics Department, Maggiore Hospital, Bologna;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Soffritti","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Maternal and Pediatrics Department, Maggiore Hospital, Bologna;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina","family":"Ancora","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Infermi Hospital, Rimini;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Palma","family":"Mammoliti","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Infermi Hospital, Rimini;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giancarlo","family":"Gargano","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Obstetrics, Gynecology and Pediatrics Department, Arcispedale Santa Maria Nuova Hospital, IRCCS, Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ercole","family":"Galassi","sequence":"additional","affiliation":[{"name":"Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-peds15563","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"e1167","DOI":"10.1542\/peds.2007-0423","article-title":"Neurodevelopmental outcome of extremely low birth weight infants with posthemorrhagic hydrocephalus requiring shunt insertion","volume":"121","author":"Adams-Chapman","year":"2008"},{"key":"b2-peds15563","series-title":"Am J Infect Control","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/j.ajic.2004.11.008","article-title":"Ventriculostomy-associated infections: incidence and risk factors","volume":"33","author":"Arabi","year":"2005"},{"key":"b3-peds15563","series-title":"Eur J Paediatr Neurol","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1016\/j.ejpn.2012.04.002","article-title":"Timing of external ventricular drainage and neurodevelopmental outcome in preterm infants with posthemorrhagic hydrocephalus","volume":"16","author":"Bassan","year":"2012"},{"key":"b4-peds15563","series-title":"Radiology","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1148\/radiol.11110334","article-title":"New reference values for the neonatal cerebral ventricles","volume":"262","author":"Brouwer","year":"2012"},{"key":"b5-peds15563","series-title":"Arch Dis Child Fetal Neonatal Ed","doi-asserted-by":"publisher","first-page":"F41","DOI":"10.1136\/adc.2006.096339","article-title":"Incidence of infections of ventricular reservoirs in the treatment of post-haemorrhagic ventricular dilatation: a retrospective study (1992\u20132003)","volume":"92","author":"Brouwer","year":"2007"},{"key":"b6-peds15563","series-title":"J Pediatr","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1016\/j.jpeds.2007.10.005","article-title":"Neurodevelopmental outcome of preterm infants with severe intraventricular hemorrhage and therapy for post-hemorrhagic ventricular dilatation","volume":"152","author":"Brouwer","year":"2008"},{"key":"b7-peds15563","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1007\/s003810050461","article-title":"Alternatives to shunting","volume":"15","author":"Cinalli","year":"1999"},{"key":"b8-peds15563","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"1671","DOI":"10.1007\/s00381-014-2523-3","article-title":"Long subcutaneous tunnelling reduces infection rates in paediatric external ventricular drains","volume":"30","author":"Collins","year":"2014"},{"key":"b9-peds15563","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1007\/s00381-011-1413-1","article-title":"Posthemorrhagic hydrocephalus in very low birth weight infants\u2014a new gentle surgical technique for external ventricular drainage","volume":"27","author":"Januschek","year":"2011"},{"key":"b10-peds15563","series-title":"Neurosurgery","first-page":"80","article-title":"Neonatal ventriculosubgaleal shunts","volume":"47","author":"Fulmer","year":"2000"},{"key":"b11-peds15563","series-title":"Pediatr Neurol","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.pediatrneurol.2005.01.008","article-title":"Neurodevelopmental outcome in children with posthemorrhagic hydrocephalus","volume":"33","author":"Futagi","year":"2005"},{"key":"b12-peds15563","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"1687","DOI":"10.1007\/s00381-012-1847-0","article-title":"Implantation of Ommaya reservoir in extremely low weight premature infants with posthemorrhagic hydrocephalus: a cautious option","volume":"28","author":"Jian","year":"2012"},{"key":"b13-peds15563","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1007\/s00381-008-0628-2","article-title":"Ventriculosubgaleal shunts in the management of infective hydrocephalus","volume":"24","author":"Kariyattil","year":"2008"},{"key":"b14-peds15563","series-title":"Arch Dis Child","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1136\/adc.56.12.900","article-title":"Measurement of the growth of the lateral ventricles in preterm infants with real-time ultrasound","volume":"56","author":"Levene","year":"1981"},{"key":"b15-peds15563","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1056\/NEJM198403013100903","article-title":"Ventriculostomy-related infections. A prospective epidemiologic study","volume":"310","author":"Mayhall","year":"1984"},{"key":"b16-peds15563","series-title":"Clin Perinatol","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1016\/j.clp.2008.07.014","article-title":"The diagnosis, management, and postnatal prevention of intraventricular hemorrhage in the preterm neonate","volume":"35","author":"McCrea","year":"2008"},{"key":"b17-peds15563","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1159\/000069827","article-title":"Life expectancy of ventriculosubgaleal shunt revisions","volume":"38","author":"Tubbs","year":"2003"},{"key":"b18-peds15563","series-title":"Arch Dis Child Fetal Neonatal Ed","doi-asserted-by":"publisher","first-page":"F229","DOI":"10.1136\/adc.2010.190173","article-title":"Management of posthaemorrhagic ventricular dilatation","volume":"97","author":"Whitelaw","year":"2012"},{"key":"b19-peds15563","series-title":"Arch Dis Child Fetal Neonatal Ed","doi-asserted-by":"publisher","first-page":"F72","DOI":"10.1136\/fn.86.2.F72","article-title":"Posthaemorrhagic ventricular dilatation","volume":"86","author":"Whitelaw","year":"2002"},{"issue":"1","key":"b20-peds15563","series-title":"Cochrane Database Syst Rev","first-page":"CD000216","article-title":"Repeated lumbar or ventricular punctures in newborns with intraventricular hemorrhage","author":"Whitelaw","year":"2001"},{"key":"b21-peds15563","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1159\/000086558","article-title":"Ventriculosubgaleal shunts for posthemorrhagic hydrocephalus in premature infants","volume":"41","author":"Willis","year":"2005"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/18\/1\/article-p1.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/18\/1\/article-p1.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/18\/1\/article-p1.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T13:12:48Z","timestamp":1681564368000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/18\/1\/article-p1.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,7]]},"references-count":21,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2016.1.peds15563","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,7]]}}}