Neuroendoscopic lavage of ventricular haemorrhage

560 560 Ulrich-Wilhem Thomale

Neuroendoscopic lavage of ventricular haemorrhage

Diagnosis: Post-haemorrhagic hydrocephalus due to neonatal Intra-Ventricular Haemorrhage
  • 41-week gestation female
  • IVH at day 1
  • MR scan: large intraventricular haematomas in both lateral ventricles
  • At 34 days she developed hydrocephalus. US showed ventricular dilatation. She deteriorated clinically (bradycardia, increased head circumference)
  • Endoscopic lavage performed
  • No need for shunt
EQUIPMENT USED
  • Aesculap Minop endoscope, 0o lens (an endoscope with two additional channels beside the working channel is needed, for simultaneous irrigation and aspiration)
SURGICAL TIPS
  • Approach to the lateral ventricle where the clot is located (right)
  • Burr hole placed more lateral than usual, to allow septostomy
  • US guidance for inserting the endoscope
  • Septostomy to gain access to the opposite lateral ventricle
  • Continuous irrigation with warm (37o C) Ringer’s solution, lactate-free; up to 3 lt may be required
  • Passive outflow to avoid uncontrolled ICP increase
  • Gentle aspiration of clots with the outflow channel of the endoscope
  • Reservoir placement at the end of the procedure
  • Average operation time: 70 minutes
Pre op
Post op
CONTRIBUTOR

Ulrich-Wilhem Thomale

All cases by: Ulrich-Wilhem Thomale