gms | German Medical Science

Objective: Intraventricular hemorrhage causes significant neurological morbidity in neonates due to direct brain tissue damage and a high rate of malresorbtive hydrocephalus. We investigated the effect of endoscopic lavage (EL) for the further treatment course of the patients.

Method: Between 9/2010 and 10/2012 a total of 19 neonates (mean age: 27±15 days) with intraventricular hemorrhage were treated with EL in order to clear the ventricles from blood clots an protein overload. Indication for surgery was significant intraventricular hemorrhage (IVH) with enlargement of the ventricles and increase in head circumference. Between 1 and 3liter of warmed Ringers solution were used during the procedure to clear the supratentorial ventricles. Following EL a Rickham reservoir was inserted to warrant further CSF puncture postoperatively if needed. Clinical stability, complications and need for further CSF diversion were evaluated.

Results: In 15 patients one procedure of EL was sufficient for CSF clearance after IVH. 4 patients received an additional EL via a contralateral burr-hole. All patients were significantly stabilized in clinical state after EL compared to the preoperative state. No signkificant intraoperative or immediate postoperative complications occurred. One infection was observed after 30 days. One patient received ETV and one developed an isolated 4^th ventricle warranting aqueductoplasty after 2 months. In the follow-up period of 10.6±6.4 months VP shunting was necessary in 10 patients (52.6%). Two patients needed shunt-revisions.

Conclusions: EL is feasible in neonates with IVH under experienced and controlled circumstances. In terms of clinical condition EL did positively affect the postoperative course of all patients. The shunt rate seem to be reduced as well as shunt function could be handled with reasonable complication rate.