神经内镜灌洗(NEL)已显示出有望成为脑室内出血(IVH)和出血性心室扩张(PHVD)的新兴手术。然而,适应症有相当大的差异,目标,和NEL的手术技术。目前没有随机试验证据支持在PHVD中使用NEL。这项研究旨在就NEL的适应症和程序步骤的技术差异达成共识。在英国的儿科神经外科顾问之间进行了混合方法改进的Delphi共识过程。阶段涉及文献综述,调查,集中在线咨询,和迭代修订,直到达成>80%的共识。来自10个中心的12名儿科神经外科顾问参加了会议。包括适应症的标准化协议,3阶段手术工作流程(心室前,心室内,心室后),100%的参与者同意术后护理。案例和外科医生特定的变化被考虑和包括通过划定强制性的,可选,不推荐的步骤。就NEL标准化协议达成了专家共识,将手术工作流程划分为三个阶段,例如心室前阶段,心室内,和心室后,每个包括强制性的,可选,不推荐的步骤。这项工作为未来的试验提供了平台,培训,并实施NEL。
Neuro-endoscopic lavage (NEL) has shown promise as an emerging procedure for intraventricular haemorrhage (IVH) and post-haemorrhagic ventricular dilatation (PHVD). However, there is considerable variation with regard to the indications, objectives, and surgical technique in NEL. There is currently no randomised trial evidence that supports the use of NEL in the context of PHVD. This study aims to form a
consensus on technical variations in the indications and procedural steps of NEL. A mixed-methods modified Delphi
consensus process was conducted between consultant paediatric neurosurgeons across the UK. Stages involved literature review, survey, focused online consultation, and iterative revisions until > 80%
consensus was achieved. Twelve consultant paediatric neurosurgeons from 10 centres participated. A standardised protocol including indications, a 3-phase operative workflow (pre-ventricular, intraventricular, post-ventricular), and post-operative care was agreed upon by 100% of participants. Case- and surgeon-specific variation was considered and included through delineation of mandatory, optional, and not recommended steps. Expert
consensus on a standardised protocol for NEL was achieved, delineating the surgical workflow into three phases such as pre-ventricular, intraventricular, and post-ventricular, each consisting of mandatory, optional, and not recommended steps. The work provides a platform for future trials, training, and implementation of NEL.