The present invention relates to medicine, namely to pediatric surgery, and can be used for drainage of the lateral ventricles of newborn children with intraventricular hemorrhages.

The most common types of cerebral lesions in newborns are peri - and intraventricular hemorrhage (PIVC) in the projection of its germinative matrix. According to different authors, the incidence among newborns with a gestation 38-43 week is 1.6%, while in 55-60% is observed in the period 24-30 weeks, in patients with body weight at birth of more than 1500 g PIVK are observed in 10-20%, and body weight less than 1500 g in 50-65% (Antonov, A. Peri - and intraventricular hemorrhage in the newborn: prevention of their occurrence and progression / Agustinos // Pediatrics. - 1996. No. 5. - P.39-42).

Effects of hemorrhage may be different: hemorrhage in its germinative matrix of the tissue collapses and forms a cyst or accumulated blood breaks the ependymal layer and extends in the lateral ventricle, extending over the entire ventricular system, causing secondary occlusive hydrocephalus in 60% of cases in CPI 3 and 4 degrees. The problem of correction of pathological changes in the Central nervous system is the impossibility of ventriculoperitoneal shunt direct the military after the occurrence of the CPI and progression of hydrocephalus, due to the development of shunt dysfunction, low weight premature infants, causing sores in the projection of the pump bypass system, and preliminary rehabilitation hemorrhagic cerebrospinal fluid.

On this basis, the role of surgical correction of the CPI to rescue liquor and recovery of liquorices in the ventricular system and thereby reduce the incidence of hydrocephalus, improve prognosis and quality of life of such patients. Known surgical treatments CPI currently represented by the drainage of the lateral ventricle and ventriculomegaly drainage. When the outer drainage set one or two drainage in the lateral ventricles at the discretion of the neurosurgeon, the reorganization of the liquor is repeated washings ventricular system saline with the addition of antibiotic. Reorganization of the liquor is reached in 2-4 week installation of drainage pipes. The disadvantage of this method is the periodicity of rehabilitation, prolonged drainage pipes up to 15-25 days, which leads to the development of infectious complications, the lack of control over the pressure in the ventricular system, which can lead to hyperadrenalism States.

Another common method of treatment of the CPI is subgaleal drainage, where the catheter is fixed to the meninges, and its distal part is located in podporujicim space temporo-parietal region (Skoromets A.P. Ventriculomegaly drainage in the treatment of the severe intraventricular hemorrhage in newborn infants / Apokoronas, Evenkeel // First Russian conference in pediatric neurosurgery: proceedings / edited Antonopoulou - M., 2003. - S-91). The disadvantages of this method are quite voluminous surgical intervention for preterm newborn, duration of drainage is approximately 45-50 days, in the temporo-parietal region is formed unsightly liquor pillow. The main negative aspect of this method is the absence of a permanent reorganization of the liquor with the removal of thrombotic masses, circulating immune complexes, leading to the development of encephalomalacia.

Closest to the invention is a method of drainage of the lateral ventricles, the proposed professional Aouita (Whitelaw, A., Drainage, Irrigation and Fibrinolythic Therapy for Post-hemorrhagic Hydrocephalus for Newborn Infants Whitelaw, A lan Pople et al. // Trial Protocol Version, January, 2005). The authors have developed a method of draining the anterior horn of the lateral ventricle and posterior horns with the contralateral side using the system for external drainage of the lateral ventricles Codman (Johnson & Johnson, Piscataway, N J, USA), as fibrinolytic used TC is Navy plasminogen activator (Actilyse, Boehringer Ingelheim International GmbH, Ingelheim, Germany). The essence of the method consists of drainage and sanitation of the liquor with the use of fibrinolytic with a constant inflow of drainage tube anterior horn of the lateral ventricle and the outflow of the solution to the drainage tube posterior horns of the lateral ventricle. According to the authors of the reorganization of the liquor is achieved for 72 hours after surgery.

The disadvantages of this method are:

- drainage of the posterior horns of the lateral ventricle, which is technically more difficult and takes more time in the operating room, to the same CPI rarely localized in the projection of the posterior horns;

method requires additional financial costs in the form of the acquisition system for ventricular drainage.

The technical result in the use of the invention is to simplify the method and reduce the time of surgery.

Total for the proposed object of the invention and the method Auito are: neuroimaging using neurosonography when installing drainage in the lateral ventricle of the brain, the installation of inflow-outflow systems for rehabilitation of the liquor and removing thrombotic masses, circulating immune complexes, early rehabilitation of spinal fluid within 72-100 hours after installation of the drainage system.

The main differences of the proposed method:

1) for dreni the Finance use thin silicone drainage tube with a diameter of 2.2 mm or umbilical catheter No. 5;

2) the installation of drainage carried out in the front horns of the lateral ventricles;

3) for throttling flow solution using an infusion pump designed for holding infusion therapy in intensive care and intensive care.

The drawing shows a diagram of the proposed method.

The proposed method of drainage is as follows: all patients in the operating conditions make the installation of drains under the control of neurosonography in the projection of the front horns 1 lateral ventricles. To do this, an incision of 0.5 mm, is reached 2 cm from the midline in the projection of the coronary suture, ventricular puncture perform brain cannula, removing the mandrel and obtaining cerebrospinal fluid drainage tube 2 with a diameter of 2.2 mm or umbilical catheter No. 5 is installed in the lateral ventricle. Fixing drains carry through contraportada. 2-3 hours after stabilization of the patient's condition one of the drainage tubes connected to the inflow representing the vial with 3 dimensional scale, coupled with the infusion pump 4. The second drainage tube 5 connected to the outflow representing the second vial with 6 dimensional data. For the child are constantly monitored in the ICU. Active infusion solution is performed at the rate of 1-2 ml per hour continuously up to what Olney reorganization of the liquor.

The proposed method was operated 68 patients. Here are two clinical observations.

Example 1.

Patient K., entered the RAO at the age of 7 days with a diagnosis of Hypoxic-hemorrhagic CNS damage is severe, the CPI of 3 degrees". Child 1 pregnancy on a background of hfpn, anemia, 1 preterm birth in a period of 33 weeks, early rupture of amniotic fluid. Weight of the newborn at birth 1500 g, Apgar scale 5-6 points. The worsening condition of the child was observed on the 5th day, became lethargic, stopped sucking, increased interesest skin. After consultations on the line of the Roman Catholic Church child transferred to RAO 2 RCCH. When entering the child's condition is severe, the level of consciousness - deep stun, on examination of the reaction is reduced, is determined floating movement of the eyeballs, the child does not suck, cry quiet, long, tetraparesis, hydrocephalic head shape, large Fontanelle tense, pronounced vascular pattern of veins of the skin of the head. The child made neurosonography, which revealed the expansion of the ventricular system, the CPI of 3 degrees (blood clot in the right lateral ventricle 47 12 mm, left 34 8 mm, layering on the vascular plexus, hyperechogenicity periventricular regions). After preoperative preparation in the operating conditions produced the establishment of ventricular drainage is by the method described above, in the postoperative period remains heavy condition of the patient after 4 hours ventricular drains connected to the inflow and the outflow system with the use of a solution with anti-fibrinolytic drug, and antibacterial. In the intensive care unit was conducted continuous monitoring of the volume of liquid entering the drains and output, daily did an ultrasound to monitor the dynamics of the state of the CNS, was daily carried out the analysis of CSF, coagulation profile. Reorganization of the liquor reached at 4 days (96 hours), the system outflow-inflow disabled, drainage tubes were left to monitor intracranial pressure over the next 3 days, then removed. The child was transferred to the neonatal care unit for further treatment. Periodically conducted ultrasound study of the structures of the brain, progressive growth of the brain ventricles were observed. The child was discharged after 17 days after receipt under the supervision of a neurologist on a residence.

Example 2.

Patient N., transferred to RAO newborns of CRH in serious condition with periodic generalized epileptic seizures tonic nature at the age of 3 days. Child from 5 pregnancies going on in the background anemia of moderate severity, nephropathy, infection in the second trimester, 2 premature the periods in gestational period 28-29 weeks, weight at birth 1280 g, the performance of the child on Apgar scale 4-6-6 points. Upon receipt of the executed neurosonographic study of the brain, which revealed CPI 4 degrees on both sides (thrombotic masses completely filled the right lateral ventricle, the lumen is not defined in the left lateral ventricle dimensions clot 35 27 mm, in the parenchyma of the left parietal lobe is defined hyperechoic the formation of irregular sizes 34 to 37 mm, adjoining to the wall of the lateral ventricle in the projection of a blood clot). Changes identified by ultrasonic examination, confirmed by brain MRI. After the preliminary preparation of the child was taken into the operating room, where installed ventricular drainage under ultrasound control, which were then connected to the inflow-outflow above method. Periodically monitored indicators of hemostasis, carried out a General analysis of cerebrospinal fluid for controlling the rate of remediation and risk of ventriculitis. Reorganization of the liquor reached on the 5th day, the drains are removed on the 7th day. On neurosonography in 3 days after removal of the drainage systems revealed a moderate enlargement of the lateral ventricles (anterior horn of the right lateral ventricle of 7 mm, the anterior horn of the left lateral ventricle 8 mm, the third ventricle 5 mm, thrombotic masses not detected is about, in the parenchyma of the temporal-parietal lobe left panencephalitis cyst, soamsawali with the cavity of the left ventricle, sizes 25 to 20 mm). The child was discharged on the 24th day after receipt in good condition weighing 1950, in neurological status had significant positive dynamics: the child is active, not spit up, rough focal symptoms have been identified, a large fontanel made, not tense.

Prior to the implementation of this technique early drainage system using active flow and passive outflow of mortality in newborn infants with CPI 4 degrees was 60-70%.

Thus, implementation of the proposed method in practice can effectively carry out reorganization of the liquor in newborn infants with intraventricular hemorrhages of varying severity, taken thrombotic masses and derivatives of blood, to prevent the development of posthemorrhagic hydrocephalus, since the small child's weight, gross damage to the Central nervous system with tamponade ventricles of the brain and, as a rule, expressed by the human vital functions cause a small perspective of the treatment of these patients. When using this method of rehabilitation is achieved at 4-6 days after installation of the drainage system, in contrast to previously used methods of closed drainage of one or both as otockov, where sanitation is achieved by 15-20 a day, reduce drainage leads to a reduction of patients ' stay in hospital, improved treatment outcomes in this group of patients, out patients without the development of posthemorrhagic hydrocephalus and subsequent shunting operations.

The method of drainage of the lateral ventricles at intraventricular hemorrhages in newborns, including the installation of a drainage tube into a lateral ventricle of the brain under ultrasound control, the installation of inflow-outflow systems for rehabilitation of the liquor and removing blood derivatives using saline solution with antibacterial and anti-fibrinolytic drugs, characterized in that the drainage is installed in the front horns of the lateral ventricles, the drains use a silicone tube with a diameter of 2.2 mm or umbilical catheter 5, and fixing them to carry through contrapartida, 2-3 h after stabilization of the patient one of the drainage tubes connected to the inflow representing the vial dimensional scale, coupled with the infusion pump, the second drainage tube connected to the outflow representing the second bottle with a measuring scale, active infusion in the ventricular system carried out at the rate of 1-2 ml/h continuously to a complete reorganization of the liquor.