Neuroendoscopic lavage versus traditional surgical methods for the early management of posthemorrhagic hydrocephalus in neonates.

OBJECTIVE

Despite advances observed in neonatal neurosurgery, treatment of posthemorrhagic hydrocephalus (PHH) remains a major challenge. This study aims to observe the outcomes of the application of the neuroendoscopic method for treating early-stage posthemorrhagic hydrocephalus.

METHODS

A total of 60 medical cases were studied retrospectively. From 2016-2021, the patients were treated at the neonatal intensive care unit (NICU). As an initial neurosurgical intervention, 19 neonates (A) underwent neuroendoscopic lavage (NEL) of the ventricular system and evacuation of posthemorrhagic debris via ventricular washout. A total of 36 neonates (B) were treated via traditional surgical methods, out of which 24 neonates underwent ventricular reservoir implantation (VAD) and 12 underwent ventriculostomy (EVD). Of the 60 patients, there were 5 neonates (C), who were treated directly by ventriculoperitoneal (VP) shunting after serial ventricular/lumbar punctures. As the inclusion and surgical criteria were significantly different for this group, their data were evaluated separately. Accordingly, these patients were divided into three (A, B, and C) groups.

RESULTS

The gestational age of group A neonates (31 weeks) was slightly higher than the gestational age of group B (29.1 weeks). During their hospitalization, 15 neonates (78.94%) from group A and 26 (83.87%) neonates from group B required shunting. In group B, 5 patients (12.19%) died before the need for shunting occurred. No lethal outcomes were observed in group A, and 9 (25%) patients from group B died during hospitalization. In group A, central nervous system (CNS) infections developed in 3 patients, which is much less than the 18 patients in group B. NEL was found to give better neurological outcomes in patients with intraventricular hemorrhages. Serial ventricular/lumbar puncture can be used as a life-saving manipulation in very unstable patients to temporarily decreasing intracranial pressure. Its frequent use is associated with brain parenchymal damage and poor neurological outcome.

CONCLUSION

The neuroendoscopic method of treating neonatal posthemorrhagic hydrocephalus is a safe and effective one. Its application reduces the period of patient hospital stay, the incidence of meningitis, and the frequency of development of multiloculated hydrocephalus.