Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2025
Neuroendoscopic lavage: a single-center retrospective cohort in the USA.
СтатьяНазвание и аннотация: Перевод в очереди
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Abdelmageed Sunny, Chiu Lucinda, Dizon Maria, Thomale Ulrich-Wilhelm, Raskin Jeffrey S, DeCuypere Michael, Scoville Jonathan, Lam Sandi
Аннотация
PURPOSE: Neuroendoscopic lavage (NEL) has been described for post-hemorrhagic hydrocephalus management in intraventricular hemorrhage (IVH) of prematurity in European cohorts. We describe an initial single-center series from the USA.
METHODS: A retrospective review was performed for premature infants with IVH that underwent NEL at our institution between 2020 and 2023. Patient characteristics, clinical variables, and radiological assessments were collected.
RESULTS: Eleven patients (five female) with IVH grade III/IV underwent 13 procedures. Mean gestational age (GA) was 25 weeks and 2 days. Mean birth weight (BW) was 0.83 kg (kg). Average age at NEL was 40.4 ± 21.5 days, and mean weight was 1.51 ± 0.3 kg. Mean frontal horn index decreased from 0.68 to 0.56 after NEL (p < 0.001). Cerebrospinal fluid infection was diagnosed in 18.2%, secondary hemorrhage in 18.2%, and seizures in 27.3% of patients. One patient died postoperatively with refractory coagulopathy. Conversion to ventriculoperitoneal shunt at six-month follow-up was 8/11 (72.7%), with 50% 1-year revision-free shunt survival. No patients required a multi-catheter system. Rates of comorbidities and shunt dependency showed very strong positive correlations: hyaline membrane disease rate (R2 = 0.950), necrotizing enterocolitis (R2 = 0.999), and persistent ductus arteriosus (R2 = 0.975). Prematurity and shunt dependency showed a moderate to strong negative correlation: GA (R2 = 0.527) and BW (R2 = 0.344).
CONCLUSION: Extreme prematurity and comorbidities are associated with increased shunt dependency. However, NEL may decrease the development of complex multiloculated hydrocephalus and the need for multiple catheter systems. Larger, long-term studies are needed to define optimal timing and criteria for NEL and its benefits and impact on neurodevelopment in this fragile population.
METHODS: A retrospective review was performed for premature infants with IVH that underwent NEL at our institution between 2020 and 2023. Patient characteristics, clinical variables, and radiological assessments were collected.
RESULTS: Eleven patients (five female) with IVH grade III/IV underwent 13 procedures. Mean gestational age (GA) was 25 weeks and 2 days. Mean birth weight (BW) was 0.83 kg (kg). Average age at NEL was 40.4 ± 21.5 days, and mean weight was 1.51 ± 0.3 kg. Mean frontal horn index decreased from 0.68 to 0.56 after NEL (p < 0.001). Cerebrospinal fluid infection was diagnosed in 18.2%, secondary hemorrhage in 18.2%, and seizures in 27.3% of patients. One patient died postoperatively with refractory coagulopathy. Conversion to ventriculoperitoneal shunt at six-month follow-up was 8/11 (72.7%), with 50% 1-year revision-free shunt survival. No patients required a multi-catheter system. Rates of comorbidities and shunt dependency showed very strong positive correlations: hyaline membrane disease rate (R2 = 0.950), necrotizing enterocolitis (R2 = 0.999), and persistent ductus arteriosus (R2 = 0.975). Prematurity and shunt dependency showed a moderate to strong negative correlation: GA (R2 = 0.527) and BW (R2 = 0.344).
CONCLUSION: Extreme prematurity and comorbidities are associated with increased shunt dependency. However, NEL may decrease the development of complex multiloculated hydrocephalus and the need for multiple catheter systems. Larger, long-term studies are needed to define optimal timing and criteria for NEL and its benefits and impact on neurodevelopment in this fragile population.