Neuroendoscopic lavage for the treatment of intraventricular hemorrhage and hydrocephalus in neonates.
Object Neonatal intraventricular hemorrhage (IVH) may evolve into posthemorrhagic hydrocephalus and cause neurodevelopmental impairment. In this study, an endoscopic surgical approach directed toward the removal of intraventricular hematoma was evaluated for its safety and efficacy. Methods Between August 2010 and December 2012 (29 months), 19 neonates with posthemorrhagic hydrocephalus underwent neuro endoscopic lavage for removal of intraventricular blood remnants. During a similar length of time (29 months) from March 2008 to July 2010, 10 neonates were treated conventionally, initially using temporary CSF diversion via lumbar punctures, a ventricular access device, or an external ventricular drain. Complications and shunt dependency rates were evaluated retrospectively. Results The patient groups did not differ regarding gestational age and birth weight. In the endoscopy group, no relevant procedure-related complications were observed. After the endoscopic lavage, 11 (58%) of 19 patients required a later shunt insertion, as compared with 100% of infants treated conventionally (p < 0.05). Endoscopic lavage was associated with fewer numbers of overall necessary procedures (median 2 vs 3.5 per patient, respectively; p = 0.08), significantly fewer infections (2 vs 5 patients, respectively; p < 0.05), and supratentorial multiloculated hydrocephalus (0 vs 4 patients, respectively; p < 0.01) [corrected].Conclusions Within the presented setup the authors could demonstrate the feasibility and safety of neuro endoscopic lavage for the treatment of posthemorrhagic hydrocephalus in neonates with IVH. The nominally improved results warrant further verification in a multicenter, prospective study.
Departments of Pediatric Neurosurgery and.
Matthias
M
Schulz
Christoph
C
Bührer
Anja
A
Pohl-Schickinger
Hannes
H
Haberl
Ulrich-Wilhelm
UW
Thomale
D002543:Cerebral Hemorrhage / Q000150:complications / Q000601:surgery*; D002552:Cerebral Ventricles; D004322:Drainage / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000601:surgery*; D008297:Male; D044583:Neuroendoscopy / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013129:Spinal Puncture / Q000009:adverse effects; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
AHW = anterior horn width; DRIFT = drainage, irrigation, and fibrinolytic therapy; IVH = intraventricular hemorrhage; TOD = thalamo-occipital distance; TVW = third ventricle width; VI = ventricular index; VP = ventriculoperitoneal; endoscopic lavage; hydrocephalus; intraventricular hemorrhage; neonates; neuroendoscopy; premature infants