Endoscopic diagnosis and treatment of infants with posthemorrhagic hydrocephalus

Abstract

Objective To study the application of flexible endoscope for diagnosis and treatment of infants with posthemorrhagic hydrocephalus. Method 28 cases of infants with posthemorrhagic hydrocephalus were diagnosed and treated with flexible neuron-endoscope in our hospital, from April 2006 to October 2008. Intraventricular haemorrhage in 25, subarachnoid hemorrhage in 2 and infratentorial subdural hematoma in 1. Ventricle irrigation was performed with flexible neuro-endoscope in all patients except 1 hematoma cavity irrigation in the case of infratentorial subdural hematoma. Followed third ventriculostomy in 18 ,simultaneous choroid plexus cauterization in 7 ,lamina terminals fenestration in 4 and the multi septum fenestration in the ventricles in 1. Endoscopic opening of the foramen of magendie with transaqueductal approach in 3. Endoscopic aqueductoplasty in 6. Results Among 28 cases of infants with posthemorrhagic hydrocephalus, only 17 diagnoses occupied 60. 7% (17/28) were defined preoperatively by neural images and the other 11 were diagnosed by overall exploration to the ventricular system under flexible endoscope. Postoperative diencephalic seizures occurred in 6, obstruction in basal cistern was defined by second ETV in 2 patients on 80 days and 7 months after operation respectively. Good results showed in the follow up of 2 to 35 months(median 13.5 months) with no complications such as intraventricular infection or subdural effusion. Conclusions Overall exploration to the ventricular system under flexible endoscope is reliable for diagnosis of posthemorrhagic hydrocephalus. Ventricle irrigation to evacuate the blood blot as far as possible is benefit to decrease the opportunity of obstruction of the stoma or shunt catheter. Second ETV is worth to advocate to identify the cause of unsatisfactory operative results. Key words: Cerebral hemorrhage; Hydrocephalus; Infants; Flexible neuroendoscope