Early endoscopic ventricular irrigation for the treatment of neonatal posthemorrhagic hydrocephalus. a feasible treatment option or not ? -a multi center report-

Etüş, Volkan; Kahiloğulları, Gökmen; Karabağlı, Hakan; Ünlü, Ağahan

doi:10.5137/1019-5149.jtn.18677-16.0

Cited by 31 publications

(32 citation statements)

References 28 publications

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“…The process of DRIFT was modified during the trial due to concerns over secondary bleeds, and the trial was stopped early due to likely futility in reaching a difference in the short-term primary outcome of shunt or death. As an alternative approach, some units have reported success with more rapid clot removal (e.g., through endoscopes) or percutaneous methods of treating intra-and extra-axial intracranial hemorrhage, although no RCT has yet been published with these novel treatments (39,40). Equally, the ELVIS trial (20) has completed its recruitment and later neurodevelopmental outcomes are expected to be published soon.…”

Section: Discussionmentioning

confidence: 99%

Treatment for Post-hemorrhagic Ventricular Dilatation: A Multiple-Treatment Meta-Analysis

et al. 2020

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Objective: To perform a systematic review and multiple-treatment meta-analysis for the treatment of premature infants with post-hemorrhagic ventricular dilatation (PHVD), to prevent death or long-term neuro-disability. Design/Method: A systematic review was performed using PubMed, EMBASE, and the Cochrane Library. A free-word search was performed to identify likely relevant literature intervention trials of PHVD in preterm infants. Initially, network mapping was performed followed by performing a Bayesian random-effects model using the Markov chain Monte Carlo method. Areas under the cumulative ranking curve (SUCRA) were calculated as a measure of the probability that each intervention was likely to be the 1st, 2nd, 3rd, etc. best therapy. Primary outcome measure was death or moderate or severe neurodevelopmental outcome at or beyond 12 months of corrected age. Results: Ten different trials were identified, enrolling 700 individuals (449 for the primary outcome). Seven intervention categories were identified, and of the 15 possible pair comparisons, 6 have been studied directly. In the multiple-treatment meta-analysis, no comparison reached conventional levels of statistical significance. Drainage Irrigation and Fibrinolytic Therapy (DRIFT) had the highest probability of being the best treatment for the primary outcome (82.1%), followed by CSF removal (10.8%), conservative management (6.7%), and then diuretic therapy (0.4%). Conclusions: PHVD is a significant cause of death and disability in developed countries, yet few therapeutic options have so far been trialed. While new therapies are urgently needed for these infants, at present, NMA shows that DRIFT appears to be the most likely candidate to improve outcomes after sIVH.

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Section: Discussionmentioning

confidence: 99%

Treatment for Post-hemorrhagic Ventricular Dilatation: A Multiple-Treatment Meta-Analysis

et al. 2020

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“…4), which involves the use of an endoscope to gently irrigate the ventricular CSF, clearing the ventricles of any large clots and restoring CSF flow via a septostomy and ensuring patency of the foramina of Monro. To date, there is no class I evidence of its efficacy but retrospective evaluations have had encouraging results with the procedure showing safety, reductions in VP shunt insertion and revision rates and favourable neurodevelopmental outcome [45][46][47][48][49]. There have been no prospective comparative trials.…”

Section: Management Of the Blood And Breakdown Productsmentioning

confidence: 99%

Intraventricular haemorrhage and posthaemorrhagic ventricular dilatation: moving beyond CSF diversion

et al. 2021

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Advances in medical care have led to more premature babies surviving the neonatal period. In these babies, germinal matrix haemorrhage (GMH), intraventricular haemorrhage (IVH) and posthaemorrhagic ventricular dilatation (PHVD) are the most important determinants of long-term cognitive and developmental outcomes. In this review, we discuss current neurosurgical management of IVH and PHVD, including the importance of early diagnosis of PHVD, thresholds for intervention, options for early management through the use of temporising measures and subsequent definitive CSF diversion. We also discuss treatment options for the evolving paradigm to manage intraventricular blood and its breakdown products. We review the evidence for techniques such as drainage, irrigation, fibrinolytic therapy (DRIFT) and neuroendoscopic lavage in the context of optimising cognitive, neurodevelopmental and quality of life outcomes in these premature infants.

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“…Reports have now emerged of clot removal/ventricular washout ("endoscopic ventricular lavage") at the time of surgery for reservoir placement. 8,34 None of those reports have significant sample sizes, nor are they randomized, but the approach is intriguing and may deserve further investigation.…”

Section: Studies Related To the Management Of Premature Children Withmentioning

confidence: 99%

Prospective multicenter studies in pediatric hydrocephalus

Kestle

Riva-Cambrin

2019

Journal of Neurosurgery: Pediatrics

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Prospective multicenter clinical research studies in pediatric hydrocephalus are relatively rare. They cover a broad spectrum of hydrocephalus topics, including management of intraventricular hemorrhage in premature infants, shunt techniques and equipment, shunt outcomes, endoscopic treatment of hydrocephalus, and prevention and treatment of infection. The research methodologies include randomized trials, cohort studies, and registry-based studies. This review describes prospective multicenter studies in pediatric hydrocephalus since 1990. Many studies have included all forms of hydrocephalus and used device or procedure failure as the primary outcome. Although such studies have yielded useful findings, they might miss important treatment effects in specific subgroups. As multicenter study networks grow, larger patient numbers will allow studies with more focused entry criteria based on known and evolving prognostic factors. In addition, increased use of patient-centered outcomes such as neurodevelopmental assessment and quality of life should be measured and emphasized in study results. Well-planned multicenter clinical studies can significantly affect the care of children with hydrocephalus and will continue to have an important role in improving care for these children and their families.

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Early endoscopic ventricular irrigation for the treatment of neonatal posthemorrhagic hydrocephalus. a feasible treatment option or not ? -a multi center report-

Cited by 31 publications

References 28 publications

Treatment for Post-hemorrhagic Ventricular Dilatation: A Multiple-Treatment Meta-Analysis

Treatment for Post-hemorrhagic Ventricular Dilatation: A Multiple-Treatment Meta-Analysis

Intraventricular haemorrhage and posthaemorrhagic ventricular dilatation: moving beyond CSF diversion

Prospective multicenter studies in pediatric hydrocephalus

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