Technical Nuances in Neuroendoscopic Lavage for Germinal Matrix Hemorrhage in Preterm Infants: Twenty Tips and Pearls after More than One Hundred Procedures

Introduction: Posthemorrhagic hydrocephalus in preterm infants is a serious entity related to high mortality and morbidity. Neuroendoscopic lavage (NEL) is a suitable alternative for the management of this pathology. However, as with every endoscopic technique, it requires some experience and several cases to master. Methods: We present a descriptive study of some technical nuances, tips, and tricks that have been learned in the last 8 years with over a hundred NELs performed in preterm infants. These variations are classified into 3 categories according to their temporal relationship with the surgical procedure: preoperative stage, intraoperative stage, and postoperative stage. We include a brief description of each one and the reasons why they are included in our current clinical practice. Results: Twenty tips and pearls were described in detail and are reported here. Preoperative, intraoperative, and postoperative variations were exposed and related to the most frequent complications of this procedure: infection, cerebrospinal fluid leak, and rebleeding. Conclusions: NEL is a useful technique for the management of germinal matrix hemorrhage in preterm infants. These technical nuances have improved the results of our technique and helped us to prevent complications related to the procedure.

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Surgical Management Germinal Matrix Hemorrhage-Related Posthemorrhagic Hydrocephalus in Premature Infants

İstanbul Kanuni Sultan Süleyman Tıp Dergisi ◽

10.5222/iksstd.2020.18942 ◽

2020 ◽

Author(s):

Talat Cem Ovalıoğlu ◽

Melih Üçer

Keyword(s):

Surgical Management ◽

Premature Infants ◽

Germinal Matrix ◽

Posthemorrhagic Hydrocephalus ◽

Germinal Matrix Hemorrhage

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Germinal Matrix-Intraventricular Hemorrhage: A Tale of Preterm Infants

International Journal of Pediatrics ◽

10.1155/2021/6622598 ◽

2021 ◽

Vol 2021 ◽

pp. 1-14

Author(s):

Walufu Ivan Egesa ◽

Simon Odoch ◽

Richard Justin Odong ◽

Gloria Nakalema ◽

Daniel Asiimwe ◽

...

Keyword(s):

Preterm Infants ◽

Intraventricular Hemorrhage ◽

Very Low Birth Weight ◽

Preterm Neonates ◽

Low Birth Weight Infants ◽

Neurodevelopmental Outcomes ◽

Germinal Matrix ◽

Posthemorrhagic Hydrocephalus ◽

Management Interventions ◽

Incidence Risk

Germinal matrix-intraventricular hemorrhage (GM-IVH) is a common intracranial complication in preterm infants, especially those born before 32 weeks of gestation and very-low-birth-weight infants. Hemorrhage originates in the fragile capillary network of the subependymal germinal matrix of the developing brain and may disrupt the ependymal lining and progress into the lateral cerebral ventricle. GM-IVH is associated with increased mortality and abnormal neurodevelopmental outcomes such as posthemorrhagic hydrocephalus, cerebral palsy, epilepsy, severe cognitive impairment, and visual and hearing impairment. Most affected neonates are asymptomatic, and thus, diagnosis is usually made using real-time transfontanellar ultrasound. The present review provides a synopsis of the pathogenesis, grading, incidence, risk factors, and diagnosis of GM-IVH in preterm neonates. We explore brief literature related to outcomes, management interventions, and pharmacological and nonpharmacological prevention strategies for GM-IVH and posthemorrhagic hydrocephalus.

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Outcome, Cost Analysis, and Long-term Follow-up in Preterm Infants with Massive Grade IV Germinal Matrix Hemorrhage and Progressive Hydrocephalus

Neurosurgery ◽

10.1097/0006123-199705000-00021 ◽

1997 ◽

Keyword(s):

Cost Analysis ◽

Preterm Infants ◽

Germinal Matrix ◽

Germinal Matrix Hemorrhage ◽

Long Term Follow Up

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White matter injury but not germinal matrix hemorrhage induces elevated osteopontin expression in human preterm brains

Acta Neuropathologica Communications ◽

10.1186/s40478-021-01267-7 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Gisela Nilsson ◽

Ana A. Baburamani ◽

Mary A. Rutherford ◽

Changlian Zhu ◽

Carina Mallard ◽

...

Keyword(s):

Brain Injury ◽

White Matter ◽

Preterm Infants ◽

Tissue Injury ◽

White Matter Injury ◽

Matricellular Protein ◽

Perinatal Brain Injury ◽

Germinal Matrix ◽

Deep White Matter ◽

Germinal Matrix Hemorrhage

AbstractOsteopontin (OPN) is a matricellular protein that mediates various physiological functions and is implicated in neuroinflammation, myelination, and perinatal brain injury. However, its expression in association with brain injury in preterm infants is unexplored. Here we examined the expression of OPN in postmortem brains of preterm infants and explored how this expression is affected in brain injury. We analyzed brain sections from cases with white matter injury (WMI) and cases with germinal matrix hemorrhage (GMH) and compared them to control cases having no brain injury. WMI cases displayed moderate to severe tissue injury in the periventricular and deep white matter that was accompanied by an increase of microglia with amoeboid morphology. Apart from visible hemorrhage in the germinal matrix, GMH cases displayed diffuse white matter injury in the periventricular and deep white matter. In non-injured preterm brains, OPN was expressed at low levels in microglia, astrocytes, and oligodendrocytes. OPN expression was significantly increased in regions with white matter injury in both WMI cases and GMH cases. The main cellular source of OPN in white matter injury areas was amoeboid microglia, although a significant increase was also observed in astrocytes in WMI cases. OPN was not expressed in the germinal matrix of any case, regardless of whether there was hemorrhage. In conclusion, preterm brain injury induces elevated OPN expression in microglia and astrocytes, and this increase is found in sites closely related to injury in the white matter regions but not with the hemorrhage site in the germinal matrix. Thus, it appears that OPN takes part in the inflammatory process in white matter injury in preterm infants, and these findings facilitate our understanding of OPN’s role under both physiological and pathological conditions in the human brain that may lead to greater elucidation of disease mechanisms and potentially better treatment strategies.

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