Neuroendoscopic surgery in neonates — indication and results over a 10-year practice

Abstract

Purpose Neuroendoscopic procedures for treatment of term and preterm newborn infants, such as endoscopic lavage for posthemorrhagic hydrocephalus, are gaining popularity despite sparse data. This single-institution report compiles all neuroendoscopic surgical procedures performed in neonates during a 10-year period. Methods Charts and electronic records were reviewed of all consecutive newborns who underwent a neuroendoscopic procedure before reaching a postmenstrual age of 44 weeks between 09/2010 and 09/2020. Available documentation was reviewed regarding the performed neuroendoscopic procedure, course of disease, complications, and all re-operations throughout the first year of life. Results During the 10-year study period, 116 infants (median gestational age at birth: 29 1/7 weeks) underwent a total of 153 neuroendoscopic procedures (median postmenstrual age at surgery: 35 0/7 weeks). The most common indication at the time of the neuroendoscopic procedures (n = 153) was intraventricular hemorrhage (IVH, n = 119), intraventricular infection (n = 15), congenital malformation (n = 8), isolated 4th ventricle (n = 7), multiloculated hydrocephalus (n = 3), and tumor (n = 1). Thirty-eight of 116 children (32.8%) underwent 43 operative revisions after 153 neuroendoscopic procedure (28.1%). Observed complications requiring surgical revision were secondary infection (n = 11), CSF fistula (n = 9), shunt dysfunction (n = 8), failure of ETV (n = 6), among others. 72 children (62%) of 116 children required permanent CSF diversion via a shunt. The respective shunt rates per diagnosis were 47 of 80 (58.8%) for previously untreated IVH, 11 of 13 (84.6%) for intraventricular infection. Shunt survival rate for the first year of life was 74% for the whole cohort. Conclusion The experience with this large cohort of neonates demonstrates the feasibility of neuroendoscopic technique for the treatment of posthemorrhagic or postinfectious hydrocephalus. Rate and type of complications after neuroendoscopic procedures were within the expected range. Assessing the potential long-term benefits of neuroendoscopic techniques has to await results of ongoing studies.

Endoscopic lavage for the treatment of multiple shunt failures in children

“…There was no statistically significant correlation between the surgical method and the development In the largest series on neuroendoscopic intervention in children, NEL was performed in 138 cases. NEL was repeated in 12 cases, simultaneous V/P shunt was inserted in 27 cases, simultaneous cyst fenestration and V/P shunt were placed in two cases, simultaneous ETV was placed in four cases, and EVD was placed in one case (34). Children who were managed by NEL after the posthemorrhagic hydrocephalus a high shunt survival rate (67.7%) compared with the remaining children in the cohort managed for other diseases (56.4%).…”

“…In that study, it was emphasized that the main targets of the neuroendoscopic procedure in the premature and neonatal age groups are intraventricular hemorrhage and subsequent hydrocephalus (34).…”

Neuroendoscopic lavage versus traditional surgical methods for the early management of posthemorrhagic hydrocephalus in neonates

“…Schulz and Etus retrospectively compared the complications and potential benefits for neonates who have been treated with neuroendoscopic ventricular lavage for their PHH. According to their results, endoscopic ventricular lavage was associated with fewer overall necessary procedures, significantly fewer infections, and multiloculated hydrocephalus development [2,4,15,16]. Frassanito et al compared the results of initial ventriculosubgaleal shunt (VSgS) with the NEL-VSgS combination.…”

Neue neurochirurgische Therapieverfahren in der Neonatologie – Möglichkeiten und Voraussetzungen

“…Ventrikels treten weniger häufig auf. So konnte auch eine Verringerung eventuell notwendiger Shunt-Revisionen beobachtet werden [13].…”

“…Ausgehend von diesem Therapieprinzip wurde die neuroendoskopische Lavage (NEL) eingeführt. Neuroendoskopische Verfahren sind in der Praxis der pädiatrischen Neurochirurgie weit verbreitet, auch im Früh- und Neugeborenenalter ist die Methode etabliert, wenngleich die Fragilität dieser Patientengruppe besondere Anforderungen an das Behandlungsteam stellt 13 . Die posthämorrhagisch bedingte Erweiterung des Ventrikelsystems, welche in der Sonografie diagnostiziert wird, stellt eine notwendige Voraussetzung für die NEL dar, sie erlaubt eine anatomische Orientierung und Manövrierbarkeit des Endoskops in den supratentoriellen Ventrikeln.…”