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Ventricular Tap for Post-hemorrhagic Ventricle Dilatation: How Much CSF Should be Removed?

Priyanka Roy, Marcus Lo, Jessica Kishimoto, Soume Bhattacharya, Roy Eagleson, Aaron Fenster and Sandrine de Ribaupierre

Background: Preterm neonates are at risk for intraventricular hemorrhage (IVH) and subsequent post-hemorrhagic hydrocephalus (PHH) due to the presence of immature and fragile vasculature called germinal matrix just beneath the lateral ventricles. Temporizing treatment is done by removing fluid from the ventricles by ventricular tap (VT) or tapping an Ommaya reservoir (an intraventricular catheter system) or by inserting an external ventricular drain (EVD). Traditionally, the amount of fluid drained is dependent on the weight of the baby, as well as following clinical symptoms during the tap. This study examines how much cerebrospinal fluid (CSF) can be drawn safely during each VT.

Objective: This study aimed to find a relationship among various parameters related to VT to determine the best predictor of tap amount.

Method: In this study, data of 70 neonates having IVH were analyzed retrospectively where 11 neonates received at least one intervention during the study period of April 2012 to May 2016. We studied all available parameters regarding 42 taps obtained from 11 patients and found poor correlations (R2=0.29 to 0.38) between tap amount with age, weight and head circumference (HC), and better correlation (R2=0.55) between tap amount and total lateral ventricular volume measured by 3D head ultrasound (US). 

Conclusion: The result of this study provides support for the hypothesis that total lateral ventricle volume measured by the 3D US is the better predictor of tap amount than the weight of the neonate. The weak correlation between tap amount and weight suggests that the removal of CSF according to weight did not represent how much fluid was drawn during VT. However, the volumetric measurement of total lateral ventricles by the 3D US could be used concurrently with other physical parameters to determine the tap amount.