Neuroendoscopic Lavage: a single-center retrospective cohort in in the United States

Purpose Neuroendoscopic lavage (NEL) has been described for post-hemorrhagic hydrocephalus management in intraventricular hemorrhage (IVH) or prematurity in European cohorts. We describe an initial uni-center series from the United States. Methods Retrospective review was performed for premature infants with IVH that underwent NEL at our institution between 2020–2023. Patient characteristics, clinical variables, and radiological assessments were collected. Results Eleven patients (five female) with IVH grade III/IV underwent 13 procedures. Mean gestational age (GA) was 25 weeks and two days. Mean birth weight (BW) was 0.83 kilograms (kg). Average age at NEL was 40.4 ± 21.5 days, 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%, 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% one-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 (R ²  = 0.950), necrotizing enterocolitis (R ²  = 0.999) and persistent ductus arteriosus (R ²  = 0.975). Prematurity and shunt dependency showed a moderate to strong negative correlation, GA (R ²  = 0.527) and BW (R ²  = 0.344). Conclusion Extreme prematurity and comorbidities are associated with increased shunt dependency. However, NEL may decrease the development of complex multi-lobulated hydrocephalus and the need for future shunt revisions. 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.