Intraventricular Hemorrhage in Neonates: Endoscopic Findings and Treatment by the Use of our Newly Developed Yamadori-Type 8 Ventriculoscope

Profound intraventricular hemorrhage (IVH) has devastating effects on neonates, leading to significant neurodevelopmental morbidity. We have developed a flexible fiberoptic ventriculoscope (Yamadori-type 8), which has a conspicuously high resolving power and is equipped with a bipolar coagulator and a working channel for irrigation. Four neonates with IVH were examined and treated for the first time using the flexible ventriculoscope. The patients had grade III or IV IVH on computed tomography scans and received endoscopic operations three to four weeks after birth. In patients with IVH, fragments of old hematomas were observed as brown masses because of the presence of hemosiderin, a characteristic endoscopic finding. We have found, for the first time, IVH due to rupture of the varices of septal veins, which could be cauterized endoscopically. Hydrocephalus was relieved by irrigation, third ventriculostomy, coagulation of the choroid plexus, and adequate placement of ventriculoperitoneal shunting was performed endoscopically. The flexible ventriculofiberscope could be a useful modality for early treatment of IVH in neonates because of the minimal invasiveness. The pathogenesis of IVH should be reviewed to include septal vein varices as a possible cause of IVH.

Neuroendoscope - Intraventricular Hemorrhage - Septal Vein Varix - Hydrocephalus

References

• 1 Papile L A, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birth weight less than 1,500 mg.  J Pediatr. 1978;  2 529-534
• 2 Funato M, Tamai H, Kodaka R, Yoshioka Y, Shimada S. The moment of intraventricular hemorrhage.  Brain Dev. 1988;  10 325-327
• 3 Milhorat T H. Hydrocephalus: pathophysiology and clinical features. In: Developmental Anormalies and Neurosurgical Diseases of Childhood, 1986: 2135-2140
• 4 Volpe J J. Neurology of the Newborn, 3rd. ed. Philadelphia: WB Saunders 1995 Chapters 10 and 11: 373-463
• 5 Manwaring K H, Crone K R (eds). Neuroendoscopy. New York: Mary Ann Liebert 1992 Vol. 1
• 6 Walker M L, MacDonald J, Wright L C. The history of ventriculoscopy: where do we go from here.  Pediat Neurosurg. 1992;  18 218-223
• 7 Yamadori T, Imamura Y, Miura M. A ventriculoscope and its application for experimental neuroanatomy.  Endoscopy. 1974;  6 123-126
• 8 Inui A, Kamikawa S, Miyake S. et al . Development of flexible ventriculoscope (Yamadori type 7) and its application to experimental animals.  J Neurosci Methods. 1997;  75 1-3
• 9 Kamikawa S, Inui A, Miyake S, Kobayashi N, Kasuga M, Yamadori T, Tamaki N. Neuroendoscopic surgery for brain abscess.  Eur J Paediatr Neurol. 1997;  213 1-2
• 10 Evans N, Kluckow M. Early ductal shunting and intraventricular hemorrhage in ventilated preterm infants.  Arch Dis child. 1996;  75 F183-F186
• 11 Oka K, Yamamoto M, Ikeda K, Tomonaga M. Flexible endoneurosurgical therapy for aquedictal stenosis.  Neurosurgery. 1993;  33 236-243
• 12 Jones R FC, Kwok B CT, Stening W A, Vonau M. The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus.  Minim Invas Neurosurg. 1994;  37 28-36
• 13 Pople I K, Ettles D. The role of endoscopic choroid plexus coagulation in the management of hydrocephalus.  Neurosurgery. 1995;  36 698-702
• 14 Lewis A I, Keiper G L, Crone K R. Endoscopic treatment of loculated hydrocephalus.  J Neurosurg. 1995;  82 780-785
• 15 Sasidharan P, Marquez E, Dizon E, Sridhar C V. Developmental outcome of infants with severe intracranial-intraventricular hemorrhage and hydrocephalus with and without ventriculo-peritoneal shunt.  Child's Nerv Syst. 1986;  2 149-160
• 16 Boynton B R, Boynton C A, Merrit T A. et al . Ventriculoperitoneal shunts in low birth weight infants with intracranial hemorrhage: neurodevelopmental outcome.  Neurosurgery. 1986;  18 141-145
• 17 Kamikawa S, Inui A, Tamaki N, Kobayashi N, Yamadori T. Application of flexible neuroendoscopes to intracerebroventricular arachnoid cysts in children - Use of videoscopes. Minim Invas Neurosurg (in press)

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