Journal Pre-proof
Percutaneous Transfontanellar External Ventricular Drainage in an Extremely Low
Birth Weight Infant: 2-Dimensional Operative Video
Emanuele La Corte, MD, PhD, Micol Babini, MD, Mariella Lefosse, MD, Francesca
Nicolini, MD, Mino Zucchelli, MD
PII:

S1878-8750(21)01320-6

DOI:

https://doi.org/10.1016/j.wneu.2021.08.132

Reference:

WNEU 17777

To appear in:

World Neurosurgery

Received Date: 21 June 2021
Revised Date:

27 August 2021

Accepted Date: 28 August 2021

Please cite this article as: La Corte E, Babini M, Lefosse M, Nicolini F, Zucchelli M, Percutaneous
Transfontanellar External Ventricular Drainage in an Extremely Low Birth Weight Infant: 2-Dimensional
Operative Video, World Neurosurgery (2021), doi: https://doi.org/10.1016/j.wneu.2021.08.132.
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition
of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of
record. This version will undergo additional copyediting, typesetting and review before it is published
in its final form, but we are providing this version to give early visibility of the article. Please note that,
during the production process, errors may be discovered which could affect the content, and all legal
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© 2021 Elsevier Inc. All rights reserved.

TITLE PAGE

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Manuscript type: Video Article

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Title: Percutaneous Transfontanellar External Ventricular Drainage in an Extremely Low Birth

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Weight Infant: 2-Dimensional Operative Video

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Running title: PTEVD in ELBW infants

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Authors:

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Emanuele La Corte, MD, PhD, 1,2 Micol Babini, MD, 1 Mariella Lefosse, MD, 1 Francesca Nicolini,

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MD, 1 Mino Zucchelli, MD, 1

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ITALIA;

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1. IRCCS Istituto delle Scienze Neurologiche di Bologna, Pediatric Neurosurgery, Bologna,

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Affiliations:

Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater
Studiorum University of Bologna, Bologna, ITALIA

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Corresponding Author:

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Emanuele La Corte, M.D., Ph.D.

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Funding: None.

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Conflict of Interests: None.

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Keywords: External ventricular drainage, Post-Hemorrhagic Hydrocephalus, Intraventricular

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hemorrhage, Prematurity, Extremely Low Birth Weight Infant, Germinal Matrix Hemorrhage

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Neurosurgery Unit
Department of Biomedical and Neuromotor Sciences (DIBINEM)
Alma Mater Studiorum University of Bologna
IRCCS Istituto delle Scienze Neurologiche di Bologna
Address: Via Altura, 3, 40139, Bologna, Italy
Phone: +39 051 4966845; Fax: +39 051 4966176
Email: emanuele.lacorte2@unibo.it

MANUSCRIPT

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Manuscript type: Video Article

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Title: Percutaneous Transfontanellar External Ventricular Drainage in an Extremely Low Birth

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Weight Infant: 2-Dimensional Operative Video

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Running title: PTEVD in ELBW infants

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ABSTRACT

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Intraventricular hemorrhage (IVH) and the subsequent development of post-hemorrhagic
hydrocephalus (PHH) is one of the most serious complication of prematurity, especially in
extremely low birth weight infants1. Neuro-developmental delay, epilepsy and severe cognitive
impairment represent common sequelae of PHH2,3. A ventriculoperitoneal shunt (VPS) insertion in
such premature infants is associated with higher rates of skin erosion, infection and shunt failure4.
One therapeutic option is represented by the use of temporary cerebrospinal fluid (CSF) diversion
procedures (such as external ventricular drainage, subcutaneous reservoir and ventriculosubgaleal
shunt) to gain time avoiding the PHH secondary damages5,6.

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An extremely low birth weight (BW=653 g) infant at 24+4 gestational age weeks presented with a
grade III IVH and peri-ventricular hemorrhagic infarction five days after birth. Serial
transfontanellar ultrasound (US) disclosed a progressive PHH. Progressive symptomatic PHH,
pulmonary hemodynamic instability and suboptimal general prematurity conditions were the main
factors that led to plan a percutaneous transfontanellar US-guided EVD at the neonatal intensive
care unit. The illustrated procedure represents a bedside minimally invasive, effective, reversible
and sparing-time choice alternative to other temporary CSF diversion techniques.

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This edited, 2-dimensional operative video highlights the surgical key steps of the proposed
procedure (Video 1). All relevant patient identifiers have been removed from the video.
Nevertheless, parent’s consent was obtained regarding the procedure, video recording and
redistribution for educational purposes.

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References

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1.

Leijser LM, de Vries LS. Preterm brain injury: Germinal matrix–intraventricular hemorrhage
and post-hemorrhagic ventricular dilatation. In: Handbook of Clinical Neurology. Vol 162.
Elsevier B.V.; 2019:173-199. doi:10.1016/B978-0-444-64029-1.00008-4

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2.

Brouwer MJ, De Vries LS, Kersbergen KJ, et al. Effects of Posthemorrhagic Ventricular
Dilatation in the Preterm Infant on Brain Volumes and White Matter Diffusion Variables at
Term-Equivalent Age. J Pediatr. 2016;168:41-49.e1. doi:10.1016/j.jpeds.2015.09.083

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3.

Cizmeci MN, Groenendaal F, Liem KD, et al. Randomized Controlled Early versus Late
Ventricular Intervention Study in Posthemorrhagic Ventricular Dilatation: Outcome at 2

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Years. J Pediatr. 2020;226:28-35.e2. doi:10.1016/j.jpeds.2020.08.014

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4.

Jian L, Hang-song S, Zheng-lang L, Li-sheng Y, Heng W, Nu Z. Implantation of Ommaya
reservoir in extremely low weight premature infants with posthemorrhagic hydrocephalus: a
cautious option. doi:10.1007/s00381-012-1847-0

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5.

Zucchelli M, Lefosse M, Corvaglia L, et al. Introduction of percutaneous-tunneled
transfontanellar external ventricular drainage in the management of hydrocephalus in
extremely
low-birth-weight
infants.
J
Neurosurg
Pediatr.
2016;18(1):1-6.
doi:10.3171/2016.1.PEDS15563

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6.

Mazzola CA, Choudhri AF, Auguste KI, et al. Pediatric hydrocephalus: Systematic literature
review and evidence-based guidelines. Part 2: Management of posthemorrhagic
hydrocephalus in premature infants. J Neurosurg Pediatr. 2014;14(Supplement_1):8-23.
doi:10.3171/2014.7.PEDS14322

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Abbreviations:

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BW, birth weight

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CSF, cerebrospinal fluid

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ELBW, extremely low birth weight

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EVD, external ventricular drainage

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IVH, intraventricular hemorrhage

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PHH, post-hemorrhagic hydrocephalus

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PTEVD, percutaneous transfontanellar external ventricular drainage

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US, ultrasound

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VPS, ventriculoperitoneal shunt

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