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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Neuroendoscopy (lavage, clot reduction, septostomy) followed by surgical temporizing methods for posthemorrhagic hydrocephalus (PHH) in newborns-preliminary results

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  • Steffen Fleck - Universitätsmedizin Greifswald , Klinik und Poliklinik für Neurochirurgie , Greifswald, Deutschland
  • Ahmed El Damaty - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland
  • Sascha Marx - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland
  • Knud Linnemann - Universitätsmedizin Greifswald, Neonatologie und Pädiatrische Intensivmedizin, Greifswald, Deutschland
  • Ehab El Refaee - Klinik und poliklinik f Neurochirurgie, Universitaetsmedizin Greifswald, Zweite Affliation- Cairo University Hospitals- Cairo -Egypt, Greifswald, Deutschland
  • Henry W. S. Schroeder - Ernst-Moritz-Arndt-Universität Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
  • Matthias Heckmann - Universitätsmedizin Greifswald, Neonatologie und Pädiatrische Intensivmedizin, GREIFSWALD, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.12.04

doi: 10.3205/17dgnc067, urn:nbn:de:0183-17dgnc0675

Published: June 9, 2017

© 2017 Fleck et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: There is an on-going debate about the optimal treatment strategies for posthemorrhagic hydrocephalus (PHH) in premature infants. Recent studies show a reduction of shunt dependency after endoscopic lavage and clot removal. To determine the role of endoscopic lavage, clot reduction combined with septostomy, followed by temporizing methods (ventricular reservoir, subgaleal shunting) in order to provide a lower shunt complication rate or even to reduce shunt dependency.

Methods: In 7 preterm infants (gestational week: 23-36 (mean 27), birth weight: 595-2400 g (mean 971)) and 1 term neonate (41 wks, 3155 g) suffering from intraventricular hemorrhages (grade II-III+) we performed endoscopic lavage with warmed Ringer solution (n=8), partial clot removal (n=8), septostomy (n=5) after 13-118 days after birth (mean 38.2) followed by ventricular reservoir or subgaleal shunting including intermittent punctures. The indications for operation were progressive ventricular enlargement, enlarging head circumference combined with symptoms of intracranial hypertension.

Results: Endoscopic procedures could be safely performed (Litlle LOTTA®-Ventriculoscopic System, Storz, Tuttlingen). No secondary hemorrhage or endoscopy related morbidity/mortality occurred. One premature infant died due to pulmonary insufficiency. Permanent shunting (incl. stent to fourth ventricle (n=1)) was performed after 14 -112 (mean 57) days after first operation. No avoidance of shunting was possible in this small cohort. Afterward, shunt revision was needed in one patient due to a suspected shunt obstruction during the follow-up period of 4-26 (mean 14) months. One intraventricular cyst occurred and could be endoscopically fenestrated.

Conclusion: Neuroendoscopic interventions seem to be safe treatment options for PHH in premature infants, and might reduce later shunt complications. Earlier and more complete clot removal may even reduce shunt dependency. Further prospective evaluations with larger cohorts and longer follow-up are needed.