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Abstract：
OBJECTIVE: Intraventricular hemorrhage (IVH) of prematurity occurs in 20-38% of infants born < 28 weeks gestational age and 15% of infants born in 28-32 weeks gestational age. Treatment has evolved from conservative management and CSF diversion of temporizing and shunting procedures to include strategies aimed at primarily clearing intraventricular blood products. Neuroendoscopic lavage (NEL) aims to decrease the intraventricular blood burden under the same anesthetic as temporizing CSF diversion measures in cases of hydrocephalus from IVH of prematurity. Given the variety of neuroendoscopes, we sought to review the literature and practical considerations to help guide neuroendoscope selection when planning NEL.
METHODS: We conducted a systematic review of the literature on neuroendoscopic lavage in IVH of prematurity to examine data on the choice of neuroendoscope and outcomes regarding shunt rate. We then collected manufacturer data on neuroendoscopic devices, including inflow and outflow mechanisms, working channel specifications, and tools compatible with the working channel. We paired this information with the advantages and disadvantages reported in the literature and observations from the experiences of pediatric neurosurgeons from several institutions to provide a pragmatic evaluation of international clinical experience with each neuroendoscope in NEL.
RESULTS: Eight studies were identified; four neuroendoscopes have been used for NEL as reported in the literature. These include the Karl Storz Flexible Neuroendoscope, LOTTA® system, GAAB system, and Aesculap MINOP® system. The LOTTA® and MINOP® systems were similar in setup and instrument options. Positive neuroendoscope features for NEL include increased degrees of visualization, better visualization with the evolution of light and camera sources, the ability to sterilize with autoclave processes, balanced inflow and outflow mechanisms via separate channels, and a working channel. Neuroendoscope disadvantages for NEL may include special sterilization requirements, large outer diameter, and limitations in working channels.
CONCLUSIONS: A neuroendoscope integrating continuous irrigation, characterized by measured inflow and outflow via separate channels and multiple associated instruments, appears to be the most commonly used technology in the literature. As neuroendoscopes evolve, maximizing clear visualization, adequate inflow, measured outflow, and large enough working channels for paired instrumentation while minimizing the footprint of the outer diameter will be most advantageous when applied for NEL in premature infants.
METHODS: We conducted a systematic review of the literature on neuroendoscopic lavage in IVH of prematurity to examine data on the choice of neuroendoscope and outcomes regarding shunt rate. We then collected manufacturer data on neuroendoscopic devices, including inflow and outflow mechanisms, working channel specifications, and tools compatible with the working channel. We paired this information with the advantages and disadvantages reported in the literature and observations from the experiences of pediatric neurosurgeons from several institutions to provide a pragmatic evaluation of international clinical experience with each neuroendoscope in NEL.
RESULTS: Eight studies were identified; four neuroendoscopes have been used for NEL as reported in the literature. These include the Karl Storz Flexible Neuroendoscope, LOTTA® system, GAAB system, and Aesculap MINOP® system. The LOTTA® and MINOP® systems were similar in setup and instrument options. Positive neuroendoscope features for NEL include increased degrees of visualization, better visualization with the evolution of light and camera sources, the ability to sterilize with autoclave processes, balanced inflow and outflow mechanisms via separate channels, and a working channel. Neuroendoscope disadvantages for NEL may include special sterilization requirements, large outer diameter, and limitations in working channels.
CONCLUSIONS: A neuroendoscope integrating continuous irrigation, characterized by measured inflow and outflow via separate channels and multiple associated instruments, appears to be the most commonly used technology in the literature. As neuroendoscopes evolve, maximizing clear visualization, adequate inflow, measured outflow, and large enough working channels for paired instrumentation while minimizing the footprint of the outer diameter will be most advantageous when applied for NEL in premature infants.
摘要：
目的：早产的脑室内出血（IVH）发生在胎龄<28周龄的婴儿中有20-38％，胎龄在28-32周龄的婴儿中有15％。治疗已从保守管理和临时分流程序的CSF转移演变为包括旨在主要清除脑室内血液制品的策略。神经内镜灌洗（NEL）旨在在早产儿IVH引起的脑积水的情况下，在相同的麻醉药下减少脑室内血液负担，以临时分流措施。鉴于神经内窥镜的多样性，我们试图回顾文献和实际考虑因素,以帮助在规划NEL时指导神经内窥镜的选择.
方法：我们对早产儿IVH神经内镜灌洗的文献进行了系统综述，以检查神经内镜选择和分流率结局的数据。然后我们收集了有关神经内窥镜设备的制造商数据，包括流入和流出机制，工作通道规格，与工作通道兼容的工具。我们将这些信息与文献中报道的优点和缺点以及来自多个机构的小儿神经外科医生经验的观察结果进行了配对，以对NEL中每种神经内窥镜的国际临床经验进行务实评估。
结果：确定了8项研究；如文献报道，4种神经内窥镜已用于NEL。这些包括KarlStorz柔性神经内窥镜，LOTTA®系统,GAAB系统,和AesculapMINOP®系统。LOTTA®和MINOP®系统在设置和仪器选项方面相似。NEL的积极神经内窥镜特征包括可视化程度增加，更好的可视化与光和相机源的演变，用高压灭菌器工艺灭菌的能力，通过单独的通道平衡流入和流出机制，一个工作通道。神经内窥镜的缺点可能包括特殊的灭菌要求，大外径,和工作渠道的限制。
结论：集成连续冲洗的神经内窥镜，以通过单独的通道和多个相关仪器测量的流入和流出为特征，似乎是文献中最常用的技术。随着神经内窥镜的发展,最大化清晰的可视化，充足的流入量,测量的流出量，当应用于早产儿的NEL时,以及用于配对器械的足够大的工作通道,同时最小化外径的占用空间将是最有利的。
方法：我们对早产儿IVH神经内镜灌洗的文献进行了系统综述，以检查神经内镜选择和分流率结局的数据。然后我们收集了有关神经内窥镜设备的制造商数据，包括流入和流出机制，工作通道规格，与工作通道兼容的工具。我们将这些信息与文献中报道的优点和缺点以及来自多个机构的小儿神经外科医生经验的观察结果进行了配对，以对NEL中每种神经内窥镜的国际临床经验进行务实评估。
结果：确定了8项研究；如文献报道，4种神经内窥镜已用于NEL。这些包括KarlStorz柔性神经内窥镜，LOTTA®系统,GAAB系统,和AesculapMINOP®系统。LOTTA®和MINOP®系统在设置和仪器选项方面相似。NEL的积极神经内窥镜特征包括可视化程度增加，更好的可视化与光和相机源的演变，用高压灭菌器工艺灭菌的能力，通过单独的通道平衡流入和流出机制，一个工作通道。神经内窥镜的缺点可能包括特殊的灭菌要求，大外径,和工作渠道的限制。
结论：集成连续冲洗的神经内窥镜，以通过单独的通道和多个相关仪器测量的流入和流出为特征，似乎是文献中最常用的技术。随着神经内窥镜的发展,最大化清晰的可视化，充足的流入量,测量的流出量，当应用于早产儿的NEL时,以及用于配对器械的足够大的工作通道,同时最小化外径的占用空间将是最有利的。
