Association of Same-Session Neuroendoscopic Lavage With Ventriculoperitoneal Shunting and Outcomes in Post-hemorrhagic Hydrocephalus: A Retrospective Cohort Study

Background We aimed to assess whether adding neuroendoscopic lavage (NEL) at the time of ventriculoperitoneal shunting (VPS) provides postoperative advantages in infants with post-hemorrhagic hydrocephalus (PHH). Materials and methods We retrospectively reviewed 73 infants with PHH requiring permanent cerebrospinal fluid (CSF) diversion. Forty-two underwent combined NEL + VPS, while thirty-one underwent VPS alone. Demographic data, intraventricular hemorrhage (IVH) grade, operative characteristics, postoperative complications, reoperation rate, time to revision, and mortality were compared between groups. The primary outcome was reoperation rates. Secondary outcomes included complications and mortality. Results Baseline demographic and radiographic parameters were similar between groups. Mean operative duration was longer in the NEL + VPS group (78.4 ± 13.2 min vs. 52.6 ± 5.2 min), with comparable intraoperative blood loss (8.21 vs. 8.10 mL). Reoperation was required in nine (21.4%) patients in the NEL + VPS group compared with 17 (54.8%) in the VPS-only group. Overall complication rates and mortality were numerically lower in the NEL + VPS cohort (complications: 40.5% vs. 61.3%; mortality: 14.3% vs. 32.3%), although these differences did not reach statistical significance. Time to reoperation was shorter in the NEL + VPS group (25.1 vs. 53.5 days), and follow-up duration was comparable between cohorts. The primary outcome was reoperation rates. Secondary outcomes included complications and mortality. Conclusions This study presents a complementary perspective on the role of NEL by evaluating its use as a same-session adjunct to definitive VPS, rather than as a staged or shunt-sparing intervention, thereby reflecting a pragmatic surgical strategy in shunt-eligible infants. Our findings suggest that same-session NEL may enhance shunt performance and reduce revision requirements in infants who already require permanent CSF diversion. Further prospective multicenter studies are needed to better define optimal patient selection and long-term outcomes.