Department of Neurosurgery, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosi, San Luis Potosí, Mexico.
Department of Spine Surgery, University Hospital Cologne Clinic and Polyclinic for Orthopaedics and Emergency Surgery, Koln, Nordrhein-Westfalen, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2024 May;85(3):274-279. doi: 10.1055/s-0043-1770358. Epub 2023 Jul 28.
Neonatal intraventricular hemorrhage (IVH) may evolve into posthemorrhagic hydrocephalus and cause neurodevelopmental impairment, becoming a common complication of premature infants, occurring in up to 40% of preterm infants weighing less than 1,500 g at birth. Around 10 to 15% of preterm infants develop severe (grades III-IV) IVH. These infants are at high risk of developing posthemorrhagic hydrocephalus. Neuroendoscopic lavage (NEL) is a suitable alternative for the management of this pathology. In this study, an endoscopic surgical approach directed toward the removal of intraventricular hematoma was evaluated for its safety and efficacy.
Between August 2016 and December 2019 (29 months), 14 neonates with posthemorrhagic hydrocephalus underwent NEL for removal of intraventricular blood by a single senior neurosurgeon. Complications such as reintervention and ventriculoperitoneal (VP) shunt placement were evaluated prospectively with an 18-month follow-up on average.
In total, 14 neonates with IVH grades III and IV were prospectively recruited. Of these, six neonates did not need a VP shunt in the follow-up after neuroendoscopy (group 1), whereas eight neonates underwent a VP shunt placement (group 2). Nonsignificant difference between the groups was found concerning days after neuroendoscopy, clot extraction, third ventriculostomy, lamina terminalis fenestration, and septum pellucidum fenestration. In group 2, there was shunt dysfunction in five cases with shunt replacement in four cases.
NEL is a feasible technique to remove intraventricular blood degradation products and residual hematoma in neonates suffering from posthemorrhagic hydrocephalus. In our series, endoscopic third ventriculostomy (ETV) + NEL could be effective in avoiding hydrocephalus after hemorrhage (no control group studied). Furthermore, patients without the necessity of VP-shunt had a better GMFCS in comparison with shunted patients.
新生儿脑室出血（IVH）可能发展为出血后脑积水，并导致神经发育障碍，成为早产儿的常见并发症，在出生体重小于 1500 克的早产儿中发生率高达 40%。约 10%至 15%的早产儿发生严重（III-IV 级）IVH。这些婴儿发生出血后脑积水的风险很高。神经内镜冲洗（NEL）是治疗这种疾病的一种合适的替代方法。在这项研究中，评估了一种针对脑室血肿清除的内镜手术方法的安全性和有效性。
在 2016 年 8 月至 2019 年 12 月（29 个月）期间，由一位资深神经外科医生对 14 例出血后脑积水的新生儿进行 NEL 以清除脑室积血。前瞻性评估了包括再次干预和脑室-腹腔（VP）分流术放置在内的并发症，并在平均 18 个月的随访中进行了评估。
共前瞻性招募了 14 例 IVH 等级 III 和 IV 的新生儿。其中，6 例神经内镜后不需要 VP 分流（组 1），8 例需要 VP 分流（组 2）。两组在神经内镜后天数、血块提取、第三脑室造口术、终板开窗术和透明隔开窗术方面无显著差异。在组 2 中，有 5 例分流功能障碍，其中 4 例进行了分流置换。
NEL 是一种可行的技术，可以清除患有出血后脑积水的新生儿的脑室血液降解产物和残余血肿。在我们的系列研究中，内镜第三脑室造口术（ETV）+NEL 可以有效地避免出血后发生脑积水（未研究对照组）。此外，与分流患者相比，不需要 VP 分流的患者 GMFCS 更好。
