Extended Experience with Neuroendoscopic Lavage for Posthemorrhagic Hydrocephalus in Neonates

Abstract

Previous studies have described neuroendoscopic lavage (NEL) as a procedure for the treatment of posthemorrhagic hydrocephalus in newborn infants. This report describes complications and results in an extended case series from 2 separate hospitals. Patient records were screened for NEL procedures performed on infants with posthemorrhagic hydrocephalus between September 2010 and May 2016 (minimum follow-up period of 12 months). Efficacy of blood removal-as assessed with cerebral ultrasound, complications, eventual shunt placement rate, and subsequent shunt revisions-were recorded. Fifty-six patients (35 male) underwent NEL at a postmenstrual median age of 31 weeks and 2 days (range, 26 weeks and 1 day to 52 weeks and 3 days) and a median weight of 1523 g (range, 734-4360 g). Median follow-up was 34 months (range, 12-80). Three patients died, and 31 patients required permanent ventriculoperitoneal shunting. There was no significant correlation between the need for ventriculoperitoneal shunting and gestational age (P = 0.05), birth weight (P = 0.07), age (P = 0.17), or weight (P = 0.59) after NEL. The median number of surgical interventions per patient was 2 (range, 1-7 interventions). Revision-free shunt survival was 63.6% at 12 and 56.2% at 24 months. NEL avoided shunt placement in 43% of newborn infants with posthemorrhagic hydrocephalus. In the shunted cohort, NEL may have also decreased the frequency of subsequent shunt revisions. The influence of NEL on neurodevelopment and safety remains to be investigated further in a multicenter setup.