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Updated: May 3, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
[Surgical treatment of posthemorrhagic hydrocephalus in premature infants]
E A Bogoslovskaya1,2, S K Gorelyshev1,3, U V Tomale4
1Russian Medical Academy of Continuous Professional Education, Moscow, Russia.
Insights
Neuroendoscopic lavage is the most effective temporary treatment for posthemorrhagic hydrocephalus in premature infants, showing fewer complications and better developmental outcomes compared to other methods.
Area of Science:
- Neonatal Neurology
- Pediatric Neurosurgery
- Critical Care Medicine
Background:
- Intraventricular hemorrhage (IVH) in premature infants can lead to life-threatening hydrocephalus.
- Temporary cerebrospinal fluid drainage is crucial until infants reach a suitable weight for shunt implantation.
Purpose of the Study:
- To compare the safety and effectiveness of four temporary treatment methods for posthemorrhagic hydrocephalus.
- Evaluate outcomes including complications and long-term neurodevelopmental status.
Main Methods:
- A multicenter prospective study involving 165 premature infants with IVH.
- Compared external ventricular drainage (EVD), ventriculosubgaleal shunt (VSGS), neuroendoscopic lavage (NEL), and Ommaya reservoir.
- Assessed effectiveness, postoperative complications, and neurodevelopment at 6, 12, 24, and 36 months.
Main Results:
- Neuroendoscopic lavage (NEL) showed the lowest rates of brain tissue defect and multilocular hydrocephalus.
- NEL required permanent shunting in fewer patients (57%) compared to VSGS (88.1%).
- NEL demonstrated no infectious complications and superior motor development indicators.
Conclusions:
- Neuroendoscopic lavage is the most effective method for temporary hydrocephalus management in premature infants.
- NEL offers minimal complications, better hydrocephalus stabilization, and improved neurodevelopmental outcomes.
- NEL reduces the need for reinterventions and complex hydrocephalus development.
Rationale:
Hydrocephalus as a consequence of intraventricular hemorrhage (IVH) in premature infants is a life-threatening complication of the neonatal period. The question remains as to which methods are best to be used for temporary drainage of cerebrospinal fluid until sufficient body mass for possible shunt implantation is achieved.
Objective:
Is to compare four methods of temporary treatment of posthemorrhagic hydrocephalus in terms of their safety and effectiveness.
Material And Methods:
A multicenter (12 healthcare facilities of the Russian Federation) prospective study included 165 premature infants with IVH and signs of worsening enlargement of the ventricles. External ventricular drainage (EVD) was used in 43 observations, ventriculosubgaleal shunt (VSGS) in 93 observations, neuroendoscopic lavage (NEL) in 25 observations and Ommaya reservoir - in 4. Methods were compared by effectiveness and postoperative complications. The examination of patients in catamnesis was carried out at the age of 6, 12, 24 and 36 months.
Results:
Differences regarding brain tissue defect in the access zone (the highest in the NEL group and the lowest in EVD group, p<0.001); multilocular hydrocephalus frequency (the highest in the EVD group - 33% and the lowest in the NEL group - 17%, p<0.05); proportion of patients in need of permanent shunting (the highest indicator in the VSGS group - 88.1% and the lowest in the NEL group - 57%, p<0.001); number of infectious complications (most of all in the EVD group - 12%, the lowest in the NEL group - 0%) have been revealed. The best indicators of children's motor development have been noted in the NEL group (2.25), the worst in the EVD group - 3.75. Long-term mortality in the distant period amounted to 7%.
Conclusion:
The most effective method of temporary arresting of hydrocephalus is neuroendoscopic lavage. It has a minimal number of infectious and other complications, the best hydrocephalus stabilization, low percentage of complicated hydrocephalus (multilocular) and the best motor development indicators and does not require reinterventions.
