Neuroendoscopic lavage: a single-center retrospective cohort in the USA

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.

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.

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).

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.