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. 2022 Nov;38(11):2181-2187.
doi: 10.1007/s00381-022-05632-2. Epub 2022 Oct 7.

A standardised protocol for neuro-endoscopic lavage for post-haemorrhagic ventricular dilatation: A Delphi consensus approach

DOLPHIN-UK Collaborators
Collaborators

A standardised protocol for neuro-endoscopic lavage for post-haemorrhagic ventricular dilatation: A Delphi consensus approach

DOLPHIN-UK Collaborators. Childs Nerv Syst. 2022 Nov.

Erratum in

Abstract

Neuro-endoscopic lavage (NEL) has shown promise as an emerging procedure for intraventricular haemorrhage (IVH) and post-haemorrhagic ventricular dilatation (PHVD). However, there is considerable variation with regard to the indications, objectives, and surgical technique in NEL. There is currently no randomised trial evidence that supports the use of NEL in the context of PHVD. This study aims to form a consensus on technical variations in the indications and procedural steps of NEL. A mixed-methods modified Delphi consensus process was conducted between consultant paediatric neurosurgeons across the UK. Stages involved literature review, survey, focused online consultation, and iterative revisions until > 80% consensus was achieved. Twelve consultant paediatric neurosurgeons from 10 centres participated. A standardised protocol including indications, a 3-phase operative workflow (pre-ventricular, intraventricular, post-ventricular), and post-operative care was agreed upon by 100% of participants. Case- and surgeon-specific variation was considered and included through delineation of mandatory, optional, and not recommended steps. Expert consensus on a standardised protocol for NEL was achieved, delineating the surgical workflow into three phases such as pre-ventricular, intraventricular, and post-ventricular, each consisting of mandatory, optional, and not recommended steps. The work provides a platform for future trials, training, and implementation of NEL.

Keywords: Delphi consensus; Neuro-endoscopic lavage; Neurodevelopmental outcome; Post-haemorrhagic hydrocephalus; Post-haemorrhagic ventricular dilatation.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
Schematic of mixed-methods Delphi consensus process
Fig. 2
Fig. 2
Survey responses to additional steps to be included as part of neuro-endoscopic lavage (NEL) A and to procedure to be performed followed NEL B. CPC, choroid plexus cauterisation; ETV, external ventricular drain; VAD, ventricular access device; VSgS, ventriculosubgaleal shunt
Fig. 3
Fig. 3
Consensus-derived protocol for neuro-endoscopic lavage in post-haemorrhagic ventricular dilatation
See this image and copyright information in PMC

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