Comparative analysis of the results of endoscopic surgery and external ventricular drainage in patients with intraventricular hemorrhage

Abstract

Background. The comparison of external ventricular drainage and endoscopic surgery in patients with intraventricular hemorrhages is carried out.The aim of the study is to perform comparative analysis of external ventricular drainage and endoscopic surgery results in patients with intraventricular hemorrhage.Materials and methods. A retrospective analysis was performed in 29 patients with intraventricular hemorrhage who underwent surgery at the N. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, and the Yaroslavl Regional Clinical Hospital. Endoscopic surgery for intraventricular hemorrhage was performed in 15 cases (treatment group), and in 3 cases endoscopic removal was accompanied by external ventricular drainage. External ventricular drainage without endoscopic surgery was performed in 14 cases (control group), and in 3 of these cases local fibrinolysis was also performed. In the treatment group, mean age was 59.6 ± 16.7 years, level of consciousness per the Glasgow Coma Scale prior to surgery was 9.9 ± 3.3, severity of intraventricular hemorrhage per the Graeb Scale was 7.3 ± 2.5. In the control group, mean age was 52.8 ± 9.6 years, level of consciousness per the Glasgow Coma Scale prior to surgery was 10.7 ± 3.2, severity of intraventricular hemorrhage per the Graeb Scale was 5.0 ± 2.6. Outcomes were assessed on the 30th day after hemorrhage using the modified Rankin Scale.Results. Endoscopic method allows to effectively remove clots from the lateral and III ventricles, decreasing the volume of intraventricular hemorrhage from 7.3 ± 2.5 to 3.9 ± 2.5 points per the Graeb Scale. Comparative analysis showed no difference in hydrocephalus resolution in the treatment and control groups. There were no intracranial infectious complications in the treatment group, but in the control group bacterial meningitis was diagnosed in 2 (14.3 %) of the 14 patients. Favorable outcome (score 0–2 per the modified Rankin Scale) was observed in 40.0 % of patients in the treatment group and 28.6 % in the control group. Mortality was 13.3 % in the treatment group and 57.1 % in the control group (χ2 = 8.6, p <0.01).Conclusion. Endoscopic surgery is an effective and safe method for intraventricular hemorrhage management and third ventriculostomy for occlusive hydrocephalus resolution, allowing to achieve better functional results and decrease mortality in patients with nontraumatic intraventricular hemorrhage.