Thirteen premature infants with posthemorrhagic hydrocephalus were treated by repeated aspiration of cerebrospinal fluid using a subcutaneous ventricular catheter reservoir at the Departments of Paediatrics and Neurosurgery, University of Heidelberg, Federal Republic of Germany. Criteria for the insertion of the catheter and reservoir were as follows: 1) Increase in head circumference of more than 1 cm/week; 2) Progressive ventricular dilatation on ultrasound scan; 3) Failure of lumbar puncture route of fluid removal; or 4) Bradyardia or apneic complications of lumbar puncture. Hydrocephalus was controlled by aspiration of fluid (median 6ml) one to four times a day for an average of 40 days. Clinical signs (tense fontanelle and increasing head size) and ultrasound were unreliable indicators of the amount and frequency of fluid removal. Direct intracranial pressure measurements made through the reservoir increased the efficacy and safety of the method. Complications included skin breakdown in one, red blood cells in the cerebrospinal fluid in one, hyponatremia in eight, and hypoproteinemia in two. The authors suggest that shunting should be performed if resolution of the posthemorrhagic hydrocephalus has not occurred in an infant weighing 2000 grams and if spinal fluid protein is low. [1]

COMMENT. C. Bannister, Consultant Paediatric Neurosurgeon, Manchester, England, comments that the reservoir allows easy repeated removal of cerebrospinal fluid from the lateral ventricles and is a convenient monitor of intracranial pressure. The disadvantages include risk of infection, skin breakdown, intraventricular bleeding from rapid aspiration and pressure fluctuations, and local cortical damage secondary to catheter insertion.