Neuroendoscopic lavage for the treatment of intraventricular hemorrhage and hydrocephalus in neonates

Schulz, Matthias; Bührer, Christoph; Pohl-Schickinger, A.; Haberl, Hannes; Thomale, Ulrich‐Wilhelm

doi:10.3171/2014.2.peds13397

Cited by 108 publications

(103 citation statements)

References 27 publications

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“…Moreover, except for shunt insertion to drain cerebrospinal fluid in infants with posthemorrhagic hydrocephalus and possibly the removal of blood clots in infants with high-grade IVH [18,19], there is no treatment for established IVH and no medical therapies exist to ameliorate the neurodevelopmental sequelae of IVH. …”

Section: Introductionmentioning

confidence: 99%

Erythropoietin for the Repair of Cerebral Injury in Very Preterm Infants (EpoRepair)

et al. 2015

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Background: Preterm infants suffering from intraventricular hemorrhage (IVH) are at increased risk for neurodevelopmental impairment. Observational data suggest that recombinant human erythropoietin (rEPO) improves long-term cognitive outcome in infants with IVH. Recent studies revealed a beneficial effect of early high-dose rEPO on white matter development in preterm infants determined by magnetic resonance imaging (MRI). Objectives: To summarize the current evidence and to delineate the study protocol of the EpoRepair trial (Erythropoietin for the Repair of Cerebral Injury in Very Preterm Infants). Methods: The study involves a review of the literature and the design of a double-blind, placebo-controlled, multicenter trial of repetitive high-dose rEPO administration, enrolling 120 very preterm infants with moderate-to-severe IVH diagnosed by cranial ultrasound in the first days of life, qualitative and quantitative MRI at term-equivalent age and long-term neurodevelopmental follow-up until 5 years of age. Results and Conclusions: The hypothesis generated by observational data that rEPO may improve long-term cognitive outcomes of preterm infants suffering from IVH are to be confirmed or refuted by the randomized controlled trial, EpoRepair.

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Section: Introductionmentioning

confidence: 99%

Erythropoietin for the Repair of Cerebral Injury in Very Preterm Infants (EpoRepair)

et al. 2015

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“…The procedures used in this study show some similarities to endoscopic surgery using a flexible endoscope for intraventricular hemorrhage; however, the access is bilateral in cases with bilateral hematoma , and our method always approaches from only one side, necessitating septostomy in every case. Although previous reports have described the use of Ringer's solution for endoscopic ventricular irrigation , we have used a commercially available artificial CSF since 2009, as this product is physiologically superior to Ringer's solution for the brain .…”

Section: Discussionmentioning

confidence: 99%

Neuroendoscopic surgery for ventriculitis and hydrocephalus after shunt infection and malfunction: Preliminary report of a new strategy

Tabuchi

Kadowaki

2015

Asian J Endoscop Surgery

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If not controlled in the early stage, ventriculitis is difficult to treat neurosurgically and can lead to serious sequelae, a long course of treatment, and hospitalization. We report two cases of ventriculitis and progressive hydrocephalus after shunt infection. Both were successfully treated by neuroendoscopic septostomy in combination with thorough intraventricular irrigation through a single burr hole followed by single shunt revision. Although surgical intervention has not been established as a first-choice treatment for ventriculitis, including early-stage ventriculitis, prompt neuroendoscopic surgery appears effective for the management of ventriculitis and hydrocephalus after shunt infection. The strategy described in this report might be useful to avoid recurrent shunt infections and malfunctions, simplify a shunt, and reduce the overall duration of hospitalization.

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“…Long-term results, comparing the potential neurological benefits with the higher surgical risks, are not yet available in premature neonates [32]. According to our own observations, the neonatal patients after neurosurgical endoscopic lavage require fewer interventions for CSF diversion.…”

Section: Intraventricular Hemorrhage (Ivh) In Premature Infantsmentioning

confidence: 99%

“…Recently, endoscopic lavage of the ventricular system has been proposed, in order to remove post-hemorrhagic residuals from the ependyme and to clear CSF content [32]. This should preferentially be performed at onset of posthemorrhagic hydrocephalic configuration, which often occurs between day 10 and 28 after birth.…”

Section: Intraventricular Hemorrhage (Ivh) In Premature Infantsmentioning

confidence: 99%

Surgical Treatment for Neonatal Hydrocephalus: Catheter-Based Cerebrospinal Fluid Diversion or Endoscopic Intervention?

Krause¹,

Panteliadis²,

Hagel³

et al. 2018

OJMN

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Neonatal hydrocephalus can arise from a multitude of disturbances, among them congenital aqueductal stenosis, myelomeningocele or posthemorrhagic complications in preterm infants. Diagnostic work-up comprises transfontanellar ultrasonography, T2 weighted MRI and clinical assessment for rare inherited syndromes. Classification of hydrocephalus and treatment guidelines is based on detailed consensus statements. The recent evidence favors catheter-based cerebrospinal fluid diversion in children below 6 months, but emerging techniques such as neuroendoscopic lavage carry the potential to lower shunt insertion rates. More long-term study results will be needed to allow for individualized, multidisciplinary decision making. This article gives an overview regarding contemporary pathophysiological concepts, the latest consensus statements and most recent technical developments. KeywordsCerebrospinal Fluid, Hydrocephalus, Neonate, Neuroendoscopy, VP-Shunt The Cerebrospinal Fluid SystemThe cerebrospinal fluid (CSF) system provides mechanical protection of the brain against mild trauma, is involved in nutrient supply and waste removal, and plays a role in the circadian rhythm [1]. In humans it comprises 4 cavities in the brain, the ventricles, which normally take up about 20% of the CSF. In addition, How to cite this paper: Krause, M., Panteliadis, C.P., Hagel, C., Hirsch, F.W., Thome HydrocephalusHydrocephalus is a disbalance between CSF production and resorption. Clinical PresentationMost children with hydrocephalus suffer from a chronic disease with a rather slow progress of symptoms. Only 10% -15% of newborns with hydrocephalus show signs of elevated intracranial pressure [11].In preterm infants, hydrocephalic growth of the neurocranium is preceded by an ultrasonographically detectable enlargement of the ventricles. At this time, the endochondral bone formation of the skull fragments still allows for a certain flexibility and the small children often suffer from a multitude of additional regulatory deficits owing to their immaturity. Therefore the signs of increased intracranial pressure such as bradycardia or respiratory insufficiency are less obvious than in older children. In newborns or infants under the age of 2, the crossing of percentiles of the head circumference compared to body height and weight is the most important sign of isolated hydrocephalus [11].Typical concurring symptoms are a tight, bulging anterior fontanel, dehiscence of skull sutures, increased visibility of scalp veins and a huge frontal bone (frontal bossing). Retraction of the upper eye-lids, together with Parinaud's upgaze palsy can lead to the rare, but very impressive sunset phenomenon, with both irises plunging half below the lower eye-lids.A number of hereditary syndromes, which mostly follow a recessive inheritance, are associated with hydrocephalus (Table 2). Thus, pediatric patients suffering from hydrocephalus of unknown etiology should be examined thoroughly for stigmata indicating an inherited disease.In older children acu...

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Neuroendoscopic lavage for the treatment of intraventricular hemorrhage and hydrocephalus in neonates

Cited by 108 publications

References 27 publications

Erythropoietin for the Repair of Cerebral Injury in Very Preterm Infants (EpoRepair)

Erythropoietin for the Repair of Cerebral Injury in Very Preterm Infants (EpoRepair)

Neuroendoscopic surgery for ventriculitis and hydrocephalus after shunt infection and malfunction: Preliminary report of a new strategy

Surgical Treatment for Neonatal Hydrocephalus: Catheter-Based Cerebrospinal Fluid Diversion or Endoscopic Intervention?

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