[Treatment of posthemorrhagic hydrocephalus with intraventricular administration of recombinant plasminogen activator (rt-PA) and dexamethasone--possible prevention of permanent shunt implantation?]

Abstract

Background: In spite of substantial advances in intensive care for extremely preterm babies, including continuous monitoring and minimal handling, prevention of intracerebral hemorrhage is not successful in some cases. Unless treated adequately, a progressive posthemorrhagical hydrocephalus leads to considerable impairment of neurological outcome. Several conservative treatment strategies have been published, but often fail to avoid a permanent ventriculoperitoneal shunt implantation with its possible complications.

Patients and methods: Our therapeutical regimen of posthemorrhagical hydrocephalus focussed on resolving the mismatch between production and resorption of intracerebral fluid (ICF) by direct lysis of intracranial hematoma and fast decrease of ICF protein concentration. To achieve this goal, we instilled repeated doses of recombinant human tissue plasminogen activator (rt-PA) and dexamethasone intraventricularly, generally via external ventricle drainage systems used also to relieve the elevated intracranial pressure.

Results: Relevant complications were not observed. Conservative management without shunt operation was only possible in one out of the treated patients.

Conclusions: Controlled multicenter studies are needed for statistical assessment of treatment efficiency.