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.

Keywords: Intraventricular hemorrhage; Intraventricular infection; Neonates; Neuroendoscopic lavage; Neuroendoscopy; Posthemorrhagic hydrocephalus; Postinfectious hydrocephalus; Ventricle peritoneal shunt.

Fig. 1

Indication for neuroendoscopic procedure (n = 153) and respective performed surgical intervention. Abbreviations: IVH, intraventricular hemorrhage; IVI, intraventricular infection; manif. HC., manifest hydrocephalus; MLHC, multiloculated hydrocephalus; malform, malformation; i4thV., isolated fourth ventricle; NEL, neuroendoscopic lavage; Re-NEL, repeated neuroendoscopic lavage; EVD, external ventricular drainage; VPS, ventricular peritoneal shunt; ETV, endoscopic third ventriculocisternostomy; fenestr., endoscopic fenestration; CPC, choroid plexus coagulation; AP, endoscopic aqueductoplasty

Fig. 2

Distribution of gestational age at birth (n = 116) and postmenstrual age at the time of surgery (n = 153)

Fig. 3

Permanent shunt rates by underlying diagnosis. (The depicted data of IVH refer to the subgroup of children who underwent NEL as the primary intervention.)

Fig. 4

Kaplan–Meier plot showing survival of shunts (n = 72) during the first year after insertion. Patients treated by VP shunt for isolated IVH (n = 52) and for other reasons (n = 20) did not differ significantly in revision-free survival rate during 12 months of follow-up