Neuroendoscopic lavage for the treatment of intraventricular hemorrhage and hydrocephalus in neonates

Clinical article

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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 neuroendoscopic 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), or supratentorial multiloculated hydrocephalus (0 vs 4 patients, respectively; p < 0.01).

Conclusions

Within the presented setup the authors could demonstrate the feasibility and safety of neuroendoscopic lavage for the treatment of posthemorrhagic hydrocephalus in neonates with IVH. The nominally improved results warrant further verification in a multicenter, prospective study.

Abbreviations used in this paper: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.
Article Information

Contributor Notes

Address correspondence to: Ulrich-Wilhelm Thomale, M.D., Arbeitsbereich Pädiatrische Neurochirurgie, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin 13353, Germany. email: uthomale@charite.de.Please include this information when citing this paper: published online April 4, 2014; DOI: 10.3171/2014.2.PEDS13397.
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