Child's Nervous System

, Volume 29, Issue 5, pp 771–779 | Cite as

Endoscopic neurosurgery in preterm and term newborn infants—a feasibility report

  • Matthias Schulz
  • Christoph Bührer
  • Birgit Spors
  • Hannes Haberl
  • Ulrich-Wilhelm ThomaleEmail author
Original Paper



Neuroendoscopic procedures became essential in neurosurgical treatment of disturbed cerebrospinal fluid dynamics. While a vast number of papers report on the neuroendoscopic experience for adults and children, no series so far reported on techniques and indications for neonate infants. We present our experience for the feasibility of neuroendoscopic procedures in preterm and term newborn infants.


All preterm and term infants who underwent an endoscopic neurosurgical intervention prior to the 28th day after the previously estimated date of delivery were identified by retrospective review. Surgical procedures and techniques, complications, and further follow-up data are reported.


During the study period, 14 infants (median age at surgery, 36+2/7 weeks of gestation) underwent 20 endoscopic procedures. The performed procedures included endoscopic septostomy (n = 3), endoscopic shunt placement for multiloculated hydrocephalus (n = 4), endoscopic transaqueductal stenting for isolated fourth ventricle (n = 3), and endoscopic lavage for ventriculitis (n = 4) or for intraventricular hemorrhage (n = 6). No severe complications were seen, while two patients necessitating unexpected interventions during further follow-up (10 %).


Despite the fragility of preterm and term newborn infants, neuroendoscopic procedures may play an important role in the treatment of disturbed cerebrospinal fluid (CSF) dynamics also in this patient population. The neuroendoscopic approach may be curative in conditions like isolated lateral ventricle, may facilitate simplified and effective CSF diversion in multiloculated hydrocephalus or isolated fourth ventricle, and may be beneficial in the course of ventriculitis and intraventricular hemorrhage. Further studies must verify our experience with a bigger cohort of patients and on a multicenter basis.


Neuroendoscopic Preterm infants Neonates Hydrocephalus Septostomy Aqueductplasty Intraventricular hemorrhage Ventriculitis 


  1. 1.
    Baldauf J, Oertel J, Gaab MR, Schroeder HW (2007) Endoscopic third ventriculostomy in children younger than 2 years of age. Childs Nerv Syst 23:623–626PubMedCrossRefGoogle Scholar
  2. 2.
    Drake JM (2007) Endoscopic third ventriculostomy in pediatric patients: the Canadian experience. Neurosurgery 60:881–886, discussion 881-886PubMedCrossRefGoogle Scholar
  3. 3.
    Knaus H, Abbushi A, Hoffmann KT, Schwarz K, Haberl H, Thomale UW (2009) Measurements of burr-hole localization for endoscopic procedures in the third ventricle in children. Childs Nerv Syst 25:293–299PubMedCrossRefGoogle Scholar
  4. 4.
    Schulz M, Goelz L, Spors B, Haberl H, Thomale UW (2012) Endoscopic treatment of isolated fourth ventricle: clinical and radiological outcome. Neurosurgery 70:847–858, discussion 858-849PubMedCrossRefGoogle Scholar
  5. 5.
    Davies MW, Swaminathan M, Chuang SL, Betheras FR (2000) Reference ranges for the linear dimensions of the intracranial ventricles in preterm neonates. Arch Dis Child Fetal Neonatal Ed 82:F218–F223PubMedCrossRefGoogle Scholar
  6. 6.
    Levene MI (1981) Measurement of the growth of the lateral ventricles in preterm infants with real-time ultrasound. Arch Dis Child 56:900–904PubMedCrossRefGoogle Scholar
  7. 7.
    Buxton N, Ho KJ, Macarthur D, Vloeberghs M, Punt J, Robertson I (2001) Neuroendoscopic third ventriculostomy for hydrocephalus in adults: report of a single unit's experience with 63 cases. Surg Neurol 55:74–78PubMedCrossRefGoogle Scholar
  8. 8.
    Sacko O, Boetto S, Lauwers-Cances V, Dupuy M, Roux FE (2010) Endoscopic third ventriculostomy: outcome analysis in 368 procedures. J Neurosurg Pediatr 5:68–74PubMedCrossRefGoogle Scholar
  9. 9.
    Kombogiorgas D, Sgouros S (2006) Assessment of the influence of operative factors in the success of endoscopic third ventriculostomy in children. Childs Nerv Syst 22:1256–1262PubMedCrossRefGoogle Scholar
  10. 10.
    Ogiwara H, Dipatri AJ Jr, Alden TD, Bowman RM, Tomita T (2010) Endoscopic third ventriculostomy for obstructive hydrocephalus in children younger than 6 months of age. Childs Nerv Syst 26:343–347PubMedCrossRefGoogle Scholar
  11. 11.
    Wagner W, Koch D (2005) Mechanisms of failure after endoscopic third ventriculostomy in young infants. J Neurosurg 103:43–49PubMedGoogle Scholar
  12. 12.
    Schulz M, Bohner G, Knaus H, Haberl H, Thomale UW (2010) Navigated endoscopic surgery for multiloculated hydrocephalus in children. J Neurosurg Pediatr 5:434–442PubMedCrossRefGoogle Scholar
  13. 13.
    Spennato P, Cinalli G, Ruggiero C, Aliberti F, Trischitta V, Cianciulli E et al (2007) Neuroendoscopic treatment of multiloculated hydrocephalus in children. J Neurosurg 106:29–35PubMedGoogle Scholar
  14. 14.
    Wu Y, Green NL, Wrensch MR, Zhao S, Gupta N (2007) Ventriculoperitoneal shunt complications in California: 1990 to 2000. Neurosurgery 61:557–562PubMedCrossRefGoogle Scholar
  15. 15.
    Zuccaro G, Ramos JG (2011) Multiloculated hydrocephalus. Childs Nerv Syst 27:1609–1619PubMedCrossRefGoogle Scholar
  16. 16.
    Del Bigio MR, Bruni JE (1988) Changes in periventricular vasculature of rabbit brain following induction of hydrocephalus and after shunting. J Neurosurg 69:115–120PubMedCrossRefGoogle Scholar
  17. 17.
    Del Bigio MR, Bruni JE (1988) Periventricular pathology in hydrocephalic rabbits before and after shunting. Acta Neuropathol 77:186–195PubMedGoogle Scholar
  18. 18.
    Guzzetta F, Mercuri E, Spano M (1995) Mechanisms and evolution of the brain damage in neonatal post-hemorrhagic hydrocephalus. Childs Nerv Syst 11:293–296PubMedCrossRefGoogle Scholar
  19. 19.
    Brouwer AJ, Brouwer MJ, Groenendaal F, Benders MJ, Whitelaw A, de Vries LS (2012) European perspective on the diagnosis and treatment of posthaemorrhagic ventricular dilatation. Arch Dis Child Fetal Neonatal Ed 97:F50–F55PubMedCrossRefGoogle Scholar
  20. 20.
    Tsitouras V, Sgouros S (2011) Infantile posthemorrhagic hydrocephalus. Childs Nerv Syst 27:1595–1608PubMedCrossRefGoogle Scholar
  21. 21.
    Whitelaw A (2001) Repeated lumbar or ventricular punctures in newborns with intraventricular hemorrhage. Cochrane Database Syst Rev (1):CD000216Google Scholar
  22. 22.
    de Vries LS, Liem KD, van Dijk K, Smit BJ, Sie L, Rademaker KJ et al (2002) Early versus late treatment of posthaemorrhagic ventricular dilatation: results of a retrospective study from five neonatal intensive care units in The Netherlands. Acta Paediatr 91:212–217PubMedCrossRefGoogle Scholar
  23. 23.
    Kennedy CR, Ayers S, Campbell MJ, Elbourne D, Hope P, Johnson A (2001) Randomized, controlled trial of acetazolamide and furosemide in posthemorrhagic ventricular dilation in infancy: follow-up at 1 year. Pediatrics 108:597–607PubMedCrossRefGoogle Scholar
  24. 24.
    Whitelaw A, Pople I, Cherian S, Evans D, Thoresen M (2003) Phase 1 trial of prevention of hydrocephalus after intraventricular hemorrhage in newborn infants by drainage, irrigation, and fibrinolytic therapy. Pediatrics 111:759–765PubMedCrossRefGoogle Scholar
  25. 25.
    Whitelaw A, Evans D, Carter M, Thoresen M, Wroblewska J, Mandera M et al (2007) Randomized clinical trial of prevention of hydrocephalus after intraventricular hemorrhage in preterm infants: brain-washing versus tapping fluid. Pediatrics 119:e1071–e1078PubMedCrossRefGoogle Scholar
  26. 26.
    Whitelaw A, Jary S, Kmita G, Wroblewska J, Musialik-Swietlinska E, Mandera M et al (2010) Randomized trial of drainage, irrigation and fibrinolytic therapy for premature infants with posthemorrhagic ventricular dilatation: developmental outcome at 2 years. Pediatrics 125:e852–e858PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Matthias Schulz
    • 1
  • Christoph Bührer
    • 2
  • Birgit Spors
    • 3
  • Hannes Haberl
    • 1
  • Ulrich-Wilhelm Thomale
    • 1
    • 4
    Email author
  1. 1.Department of Pediatric NeurosurgeryCharité University Medical CenterBerlinGermany
  2. 2.Department of NeonatologyCharité University Medical CenterBerlinGermany
  3. 3.Department of Pediatric RadiologyCharité University Medical CenterBerlinGermany
  4. 4.Arbeitsbereich Pädiatrische NeurochirurgieCharité Universitätsmedizin BerlinBerlinGermany

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