Endoscopic lavage and application of rTPA in multiloculated hydrocephalus: a mono-center experience

Abstract Objective: This study focuses on treatment of multiloculated hydrocephalus (HCP) following ventricular infection. Post-infectious hydrocephalus in the premature infant is a complicated disease and dire to treat as it tends to re-occur despite multiple surgical procedures. Here, we report our experience in rtPA (recombinant tissue-type plasminogen activator) application and neuroendoscopic lavage to treat post-infectious HCP. Methods: This retrospective series comprises on six premature infants with a history of intraventricular infection. In the course of treatment, neuroendoscopy, external ventricular drainage, antibiotic treatment and lavage have been performed. rtPA has been applied intraventricularily in three patients in individual regimen (s. below) to dissolve membranes, septs and cysts to facilitate cerebro-spinal fluid (CSF) circulation. Besides clinical outcome CSF and laboratory parameters as well as MR/sonographic morphology are evaluated.Results: Here, rtPA application did not cause hemorrhagic complications. Improvement of CSF parameters, such as lactate, glucose and protein levels, was limited while MRI and ultrasound imaging demonstrated successful dissolving of intraventricular septs and cysts. The overall neurological outcome was poor. Thus, a beneficial impact of rtPA installation on the neurological outcome remains uncertain.Conclusion: In our experience, rtPA was safely instilled to dissolve intraventricular septation and to reduce protein precipitation in ventriculitis in neonates and preterm infants. Shunt interventions were presumably reduced in our cohort, probably due to prevention of multiloculated hydrocephalus. A beneficial impact on neurological status was absent as clinical outcome was generally poor. Outcome scores did not apply, or showed no difference, respectively.