Neuroendoscopic lavage in neonatal posthemorrhagic hydrocephalus: a systematic review and single-arm meta-analysis

OBJECTIVE Posthemorrhagic hydrocephalus (PHH) is a significant complication of intraventricular hemorrhage (IVH) in preterm neonates. Neuroendoscopic lavage (NEL) is a treatment option. The authors aimed to evaluate the effectiveness and safety of NEL alone for early treatment of PHH in neonates. METHODS This systematic review and meta-analysis were conducted according to Cochrane Collaboration guidelines and the PRISMA statement. A comprehensive search of databases (PubMed, Embase, Google Scholar, and Web of Science) was conducted to identify studies evaluating NEL in the treatment of PHH in neonates. The analysis used random-effects models. The primary outcome was dependency on a ventriculoperitoneal (VP) shunt. Secondary outcomes included infection rates, multiloculated hydrocephalus, and mortality. RESULTS The authors evaluated 312 neonates from 9 studies. The pooled analysis revealed a shunt dependency rate of 58.3% (95% CI 52.5–64.2%, I2 = 10%). The infection rate was 5.6% (95% CI 1.7–9.6%, I2 = 48.4%), while the incidence of multiloculated hydrocephalus was 6.5% (95% CI 1.56–11.4%, I2 = 32.6%). Mortality was low at 2.4% (95% CI 0%–4.9%, I2 = 25.2%). CONCLUSIONS This meta-analysis of NEL for neonatal PHH showed moderate rates of shunt dependence, along with low rates of infection and mortality. These findings suggest that NEL is a safe procedure associated with relatively low VP shunt dependence; however, well-designed randomized controlled trials are required to confirm these results and to compare NEL with traditional management strategies. © AANS 2026, except where prohibited by US copyright law