Intraventricular hemorrhage in neonates: endoscopic findings and treatment by the use of our newly developed Yamadori-type 8 ventriculoscope.

Profound intraventricular hemorrhage (IVH) has devastating effects on neonates, leading to significant neurodevelopmental morbidity. We have developed a flexible fiberoptic ventriculoscope (Yamadori-type 8), which has a conspicuously high resolving power and is equipped with a bipolar coagulator and a working channel for irrigation. Four neonates with IVH were examined and treated for the first time using the flexible ventriculoscope. The patients had grade III or IV IVH on computed tomography scans and received endoscopic operations three to four weeks after birth. In patients with IVH, fragments of old hematomas were observed as brown masses because of the presence of hemosiderin, a characteristic endoscopic finding. We have found, for the first time, IVH due to rupture of the varices of septal veins, which could be cauterized endoscopically. Hydrocephalus was relieved by irrigation, third ventriculostomy, coagulation of the choroid plexus, and adequate placement of ventriculoperitoneal shunting was performed endoscopically. The flexible ventriculofiberscope could be a useful modality for early treatment of IVH in neonates because of the minimal invasiveness. The pathogenesis of IVH should be reviewed to include septal vein varices as a possible cause of IVH.