Posthemorrhagic hydrocephalus in prematures: Neuroendoscopic ventricular lavage

Abstract

Intraventricular hemorrhage resulting in hydrocephalus in premature infants represents a challenging clinical condition leading to significant neurodevelopmental impairment. Temporizing CSF diversion techniques are used with relatively high complication rates in these patients. In order to control hydrocephalus and eradicate the intraventricular blood, neuroendoscopic lavage is introduced in order to stabilize the clinical course of the patients, to reduce shunt dependency, and to ameliorate neurodevelopmental outcome. The intervention can be performed in a controlled environment of the operating room in order to wash out soluble blood products and gently aspirate hematoma clots. A ventricular access device is implanted for possible CSF relief when hydrocephalus reoccurs. The intervention necessitate close interaction of an experienced interdisciplinary team performing a stable transport under anesthesia and a safe endoscopic procedure. Limited data from retrospective cohort studies show that neuroendoscopic lavage is safely feasible in experienced hands and reduces the shunt rate as well as the necessity for further surgical interventions. Prospective multicenter data collection is necessary in order to proof the long-term benefit for the patients.