Relation between TGF-beta 1 levels in cerebrospinal fluid and ETV outcome in premature newborns with posthemorrhagic hydrocephalus
Abstract
Therapy of posthaemorrhagic hydrocephalus (PHH) by using ventriculo-peritoneal drainage bears considerable rate of complications and remains a challenge in premature newborns. The role of endoscopic third ventriculostomy (ETV) in these patients is unclear, through obstruction is proven in some patients with PHH.
Transforming growth factor beta 1 (TGF-beta 1) release into the cerebrospinal fluid (CSF) in time of primary bleeding is suggested as one of the possible pathophysiologic reasons of PHH formation. Relation between TGF-beta 1 levels and ETV success rate has not been reported yet.
The aim of our study is to detect group of patients, according to the levels of TGF-beta 1, who have magnetic resonance imaging (MRI)-proven obstruction hydrocephalus without participation of hyporesorption-so that we can expect success of ETV. We followed 29 premature newborns with PHH during 2005-2007, all of them treated by Ommaya reservoir implantation and repeated taps with TGF-beta 1 levels examination.
In case of persisting hydrocephalus, MRI was performed. In 16 patients with proven obstruction, ETV was performed.
We were successful in six patients (37,5%). We evaluated patophysiological type of hydrocephalus and ETV succes rate and their relation to TGF-beta 1 CSF levels.
We have proven statistically relevant probability in diagnosis of hyporesorptive hydrocephalus based on TGF-beta 1 level in CSF. Value exceeding 3,296 pg/ml means 81,3% probability of present hyporesorption.
Succes rate of ETV in patiens with MRI-verified obstruction and TGF-beta 1 level lower than 3,296 pg/ml was 100% in our series. TGF-beta 1 level indicates participation of hyporesorption in hydrocephalus development and its level may influence decision making in ETV for premature newborns with PHH.