Is ventricular lavage a novel treatment of neonatal posthemorrhagic hydrocephalus? a meta analysis

• Published in: Child's nervous system Vol. 39; no. 4; pp. 929 - 935
• Main Authors: Parenrengi, Muhammad Arifin, Ranuh, IG. M. Aswin R., Suryaningtyas, Wihasto
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-04-2023
• Subjects: Cerebral Hemorrhage - surgery; Cerebral Ventricles - surgery; Cerebrospinal Fluid Shunts; Humans; Hydrocephalus - surgery; Hydrocephalus - therapy; Infant, Newborn; Medicine; Medicine & Public Health; Neurosciences; Neurosurgery; Original Article; Therapeutic Irrigation - methods; Ventriculoperitoneal Shunt; Cerebrospinal diversion; Neonates; Intraventricular hemorrhage; Ventriculoperitoneal shunt; Posthemorrhagic hydrocephalus; Neuroendoscopic lavage
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-022-05790-3

Introduction
Intraventricular hemorrhage (IVH) may produce obliterative arachnoiditis, which disrupts the flow and absorption of cerebrospinal fluid (CSF), resulting in posthemorrhagic hydrocephalus (PHH). PHH gives a high risk of neurofunctional impairment.
Ventricular lavage is the treatment of choice for PHH in neonates with IVH for decades. It is developing with the combination of fibrinolytic therapy, also called drainage, irrigation, and fibrinolytic therapy (DRIFT), and with the use of neuroendoscopic apparatus, also called neuroendoscopic lavage (NEL).
Methods
This review is a meta-analysis using the PRISMA method guideline, including the clinical studies comparing ventricular lavage (VL) with standard treatment of PHH between 2000 and 2021.
Results
VL group reduced the shunt dependency compared to standard treatment (OR = 0.22; 95CI 0.05 to 0.97;
p
 = 0.05). VL group has less infection risk compared to the standard treatment group (RR = 0.20; 95CI 0.07 to 0.59;
p
 < 0.05). The severe neurofunctional outcome is similar between the two groups (OR = 0.99; 95CI 0.13 to 7.23;
p
 = 0.99). The early approach treatment group may give better neurofunctional outcomes compared to the late approach (OR = 0.14; 95CI 0.06 to 0.35;
p
 < 0.05).
Conclusion
VL reduce the shunt dependency on the PHH, decreasing the shunt’s related infection rate. The early ventricular lavage may give benefit for the neurocognitive outcome.