Childs Nerv Syst. 2022 Nov;38(11):2181-2187. doi: 10.1007/s00381-022-05632-2. Epub 2022 Oct 7.
Neuro-endoscopic lavage (NEL) has shown promise as an emerging procedure for intraventricular haemorrhage (IVH) and post-haemorrhagic ventricular dilatation (PHVD). However, there is considerable variation with regard to the indications, objectives, and surgical technique in NEL. There is currently no randomised trial evidence that supports the use of NEL in the context of PHVD. This study aims to form a consensus on technical variations in the indications and procedural steps of NEL. A mixed-methods modified Delphi consensus process was conducted between consultant paediatric neurosurgeons across the UK. Stages involved literature review, survey, focused online consultation, and iterative revisions until > 80% consensus was achieved. Twelve consultant paediatric neurosurgeons from 10 centres participated. A standardised protocol including indications, a 3-phase operative workflow (pre-ventricular, intraventricular, post-ventricular), and post-operative care was agreed upon by 100% of participants. Case- and surgeon-specific variation was considered and included through delineation of mandatory, optional, and not recommended steps. Expert consensus on a standardised protocol for NEL was achieved, delineating the surgical workflow into three phases such as pre-ventricular, intraventricular, and post-ventricular, each consisting of mandatory, optional, and not recommended steps. The work provides a platform for future trials, training, and implementation of NEL.
神经内镜冲洗术（NEL）作为一种治疗脑室内出血（IVH）和出血后脑室扩张（PHVD）的新兴方法，显示出了良好的效果。然而，在 NEL 的适应证、目标和手术技术方面存在着相当大的差异。目前尚无随机试验证据支持在 PHVD 背景下使用 NEL。本研究旨在就 NEL 的适应证和操作步骤的技术差异达成共识。在英国，顾问级小儿神经外科医生采用混合方法改良 Delphi 共识程序进行了研究。研究涉及文献回顾、调查、重点在线咨询和迭代修订，直到达成>80%的共识。来自 10 个中心的 12 名顾问级小儿神经外科医生参与了研究。100%的参与者同意了一个包括适应证、3 个阶段的手术工作流程（脑室前、脑室中和脑室后）和术后护理的标准化方案。考虑到了病例和外科医生的具体差异，并通过定义强制性、选择性和不推荐性步骤来包括这些差异。已经就 NEL 的标准化方案达成了专家共识，将手术工作流程划分为三个阶段，如脑室前、脑室中和脑室后，每个阶段都包括强制性、选择性和不推荐性步骤。该研究为未来的试验、培训和 NEL 的实施提供了一个平台。
