Child's Nervous System

, Volume 23, Issue 7, pp 765–771 | Cite as

The role of Ommaya reservoir and endoscopic third ventriculostomy in the management of post-hemorrhagic hydrocephalus of prematurity

  • Paola PerettaEmail author
  • Paola Ragazzi
  • Christian F. Carlino
  • Pierpaolo Gaglini
  • Giuseppe Cinalli
Original Paper



The aim of this study is to retrospectively evaluate a series of consecutive patients affected by post-hemorrhagic hydrocephalus in prematurity, treated with an implant of an Ommaya reservoir followed by ventriculo-peritoneal (VP) shunt and/or endoscopic third ventriculostomy (ETV) to evaluate the safety and efficacy of these treatment options in the management of the condition.


Between 2002 and 2005, 18 consecutive premature patients affected by intra-ventricular haemorrhage (IVH) grades II to IV, presenting with progressive ventricular dilatation, were operated for implant of an intra-ventricular catheter connected to a sub-cutaneous Ommaya reservoir. Cerebrospinal fluid was intermittently aspirated percutaneously by the reservoir according with the clinical requirements and the echographic follow-up. The patients who presented a progression of the ventricular dilatation were finally operated for VP shunt implant or ETV according with the MRI findings.


One patient had grade II, 5 had grade III, and 12 had grade IV IVH. The mean age at IVH diagnosis was 5.2 days; the mean age at reservoir implant was 17.3 days. The Ommaya reservoir was punctured on an average basis of 11.4 times per patient (range 2–25), and the mean interval between aspirations was 2.7 days. The mean CSF volume per tap was 20 ml. One patient died for pulmonary complications during the study period. Out of the 17 survivors, 3 did not develop progressive ventricular dilatation, and their reservoir was removed; 14 developed progressive hydrocephalus, 5 of whom were implanted with a VP shunt and 9 received an ETV. Amongst the five shunted patients, two were re-admitted for shunt malfunction and had their shunt removed after ETV after 6.1 and 20.5 months, respectively. Amongst the nine patients who received an ETV, five had to be re-operated for VP shunt implant at an average interval of 2.17 months (range 9–172 days) because of increasing ventricular dilatation. Two of them had a redo third ventriculostomy with shunt removal at 11 and 25.1 months, respectively, after insertion. The first was reimplanted with a VP shunt 4 days later; the second remains shunt free. Therefore, at the end of the follow-up period, 10 out of 17 children affected by post-hemorrhagic hydrocephalus in prematurity were shunt free (59%).


The combination of Ommaya reservoir, VP shunt, and the aggressive use of ETV as a primary treatment or as an alternative to shunt revision allowed for a significant reduction of shunt dependency in a traditionally shunt-dependent population. Further studies are warranted to optimise the algorithm of treatment in these patients.


Post-hemorrhagic hydrocephalus Premature Ommaya reservoir Ventricular access device Endoscopic third ventriculostomy 


  1. 1.
    Beems T, Grotenhuis JA (2002) Is the success rate of endoscopic third ventriculostomy age-dependent? Childs Nerv Syst 18:605–608PubMedCrossRefGoogle Scholar
  2. 2.
    Berger A, Weninger M, Reinprecht A, Haschke N, Kohlhauser C, Pollack A (2000) Long-term experience with subcutaneously tunnelled external ventricular drainage in preterm infants. Childs Nerv Syst 16:103–110PubMedCrossRefGoogle Scholar
  3. 3.
    Brockmeyer D, Abtin K, Carey L, Walker ML (1998) Endoscopic third ventriculostomy: an outcome analysis. Pediatr Neurosurg 28:236–240PubMedCrossRefGoogle Scholar
  4. 4.
    Bruinsma N, Stobberingh EE, Herpers MJHM, Vles JSH, Weber BJ, Gavilanes DAWD (2000) Subcutaneous ventricular catheter reservoir and ventriculo-peritoneal drain-related infections in preterm infants and young children. Clin Microbiol Infect 6:202–206PubMedCrossRefGoogle Scholar
  5. 5.
    Buxton N, Macarthur D, Mallucci C, Punt J, Vloeberghs M (1998) Neuroendoscopy in the premature population. Childs Nerv Syst 14:649–652PubMedCrossRefGoogle Scholar
  6. 6.
    Cinalli G, Salazar C, Mallucci C et al (1998) The role of endoscopic third ventriculostomy in the management of shunt malfunction. Neurosurgery 43:1323–1329PubMedCrossRefGoogle Scholar
  7. 7.
    Cinalli G (1999) Alternatives to shunting. Childs Nerv Syst 15:718–731PubMedCrossRefGoogle Scholar
  8. 8.
    Etus V, Ceylan S (2005) Success of endoscopic third ventriculostomy in children less than 2 years of age. Neurosurg Rev 28:284–288PubMedCrossRefGoogle Scholar
  9. 9.
    Fritsch MJ, Kienke S, Ankermann T, Padoin M, Mehdorn M (2005) Endoscopic third ventriculostomy in infants. J Neurosurg (Pediatrics) 103:50–53Google Scholar
  10. 10.
    Gaskill SJ, Marlin Ae, Rivera S (1988) The subcutaneous ventricular reservoir: an effective treatment for posthemorrhagic hydrocephalus. Childs Nerv Syst 4:291–295PubMedCrossRefGoogle Scholar
  11. 11.
    Hansen A, Volpe JJ, Goumnerova LC, Madsen JR (1997) Intraventricular urokinase for the treatment of posthemorrhagic hydrocephalus. Pediatr Neurosurg 17:213–217Google Scholar
  12. 12.
    Heep A, Engelskirchen R, Holschneider A, Groneck P (2001) Primary intervention for post-hemorrhagic hydrocephalus in very low birthweight infants by ventriculostomy. Childs Nerv Syst 17:47–51PubMedCrossRefGoogle Scholar
  13. 13.
    Kennedy CR, Ayers S, Campbell MJ, Elbourne D, Hope P, Johnson A (2001) Randomised, controlled trial of acetazolamide and furosemide in post-hemorrhagic ventricular dilatation in infancy: follow-up at 1 year. Pediatrics 108:597–607PubMedCrossRefGoogle Scholar
  14. 14.
    Luciano R, Velardi F, Romagnoli C, Papacci P, De Stefano V, Tortorolo G (1997) Failure of fibrinolytic endoventricular treatment to prevent neonatal post-hemorrhagic hydrocephalus. Childs Nerv Syst 13:73–76PubMedCrossRefGoogle Scholar
  15. 15.
    Massone ML, Cama A, Leone D, Pellas E, Vallarino R, Carini S, Andreussi L (1994) Results of early external ventricular diversion in posthemorrhagic ventricular dilatation in the newborn. Minerva Anestesiol 60:663–668 [Itl]PubMedGoogle Scholar
  16. 16.
    Mc Comb JG, Ramos AD, Platzker ACG, Henderson DJ, Segall HD (1983) Management of hydrocephalus secondary to intraventricular hemorrhage in the preterm infant with a subcutaneous ventricular catheter reservoir. Neurosurgery 13:295–300CrossRefGoogle Scholar
  17. 17.
    Reinprecht A, Dietrich W, Berger A, Bavinzski G, Weninger M, Czech T (2001) Posthemorrhagic hydrocephalus in preterm infants: long-term follow-up and shunt related complications. Childs Nerv Syst 17:663–669PubMedCrossRefGoogle Scholar
  18. 18.
    Richard E, Cinalli G, Assis D, Pierre-Kahn A, Lacaze-Masmonteil T (2001) Treatment of post-haemorrhage ventricular dilatation with an Ommaya’s reservoir: management and outcome of 64 preterm infants. Childs Nerv Syst 17:334–340PubMedCrossRefGoogle Scholar
  19. 19.
    Scavarda D, Bedmarek N, Litre F, Koch C, Lena G, Morville P, Rousseaux P (2003) Acquired aqueductal stenosis in preterm infants: an indication for neuroendoscopic third ventriculostomy. Childs Nerv Syst 19:756–759PubMedCrossRefGoogle Scholar
  20. 20.
    Siomin V, Cinalli G, Grotenhuis A, Golash A, Oi S, Kothbauer K, Weiner H, Roth J, Beni-Adani L, Pierre-Kahn A, Takahashi Y, Mallucci C, Abbott R, Wisoff J, Constantini S (2002) Endoscopic third ventriculostomy in patients with cerebrospinal fluid infection and/or hemorrhage. J Neurosurg 97:519–524PubMedCrossRefGoogle Scholar
  21. 21.
    Ventriculomegaly Trial Group (1990) Randomised trial of early tapping in neonatal post-hemorrhagic ventricular dilatation. Arch Dis Child 65:3–10Google Scholar
  22. 22.
    Wagner W, Koch D (2005) Mechanism of failure after endoscopic third ventriculostomy in young infants. J Neurosurg (Pediatrics) 103:43–49Google Scholar
  23. 23.
    Whitelaw A, Rivers RPA, Creighton L, Gaffney P (1992) Low dose intraventricular fibrinolytic treatment to prevent posthemorrhagic hydrocephalus. Arch Dis Child 67:12–14PubMedCrossRefGoogle Scholar
  24. 24.
    Whitelaw A, Saliba E, Fellman V, Mowinkel MC, Acolet D, Marlow N (1996) A phase I study of intraventricular recombinant tissue plasminogen activator for the treatment of posthemorrhagic hydrocephalus. Arch Dis Child 75:F20–F26Google Scholar
  25. 25.
    Whitelaw A (2001) Intraventricular haemorrhage and posthaemorrhagic hydrocephalus: pathogenesis, prevention and future interventions. Semin Neonatol 6:135–146PubMedCrossRefGoogle Scholar
  26. 26.
    Whitelaw A, Pople I, Cherian S, Evans D, Thoresen M (2003) Phase 1 trial of prevention of hydrocephalus after intraventricular hemorrhage in newborn infants by drainage, irrigation and fibrinolytic therapy. Pediatrics 111:759–765PubMedCrossRefGoogle Scholar
  27. 27.
    Whitelaw A, Cherian S, Thoresen M, Pople I (2004) Posthaemorrhagic ventricular dilatation: new mechanisms and new treatment. Acta Paediatr Suppl 444:11–14Google Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Paola Peretta
    • 1
    Email author
  • Paola Ragazzi
    • 1
  • Christian F. Carlino
    • 1
  • Pierpaolo Gaglini
    • 1
  • Giuseppe Cinalli
    • 2
  1. 1.Pediatric NeurosurgeryRegina Margherita Children’s HospitalTurinItaly
  2. 2.Pediatric NeurosurgerySantobono–Pausilipon Children’s HospitalNaplesItaly

Personalised recommendations