Efficacy and safety profile of neuroendoscopic hematoma evacuation combined with intraventricular lavage in severe intraventricular hemorrhage patients

Ding, Huaiyu; Han, Yao; Sun, D Z; Nie, Quanmin

doi:10.1002/brb3.1756

Cited by 8 publications

(2 citation statements)

References 16 publications

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“…One RCT with 81 patients suffering from IVH, evaluated cisternal irrigation with saline and gentamicin during surgery versus trepanation drainage and found a significantly increased rate of favourable outcome (ADL=good/excellent) in patients treated with cisternal irrigation at 3 months after surgery (92.1% vs 82.5%, p<0.01). 35 Another RCT with 21 patients 36 evaluated the effect of intraventricular irrigation using the irrigation system IRRAflow, 37 using a dual-lumen catheter for automatised fluid exchange based on periodic irrigation and aspiration. 38 The study was terminated early, due to safety concerns, 36 as they found that the intervention group had a higher rate of catheter occlusion Cisternal irrigation overall compared with conventional treatment for subarachnoid haemorrhage [13][14][15][16][17][18][19][20][21][22] Mortality…”

Section: Open Access Table 1 Summary Of Findings and Grade Assessmentmentioning

confidence: 99%

Cisternal and intraventricular irrigation in subarachnoid and intraventricular haemorrhage

Lind,

Krabbenhøft,

Valentin

et al. 2024

Stroke Vasc Neurol

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BackgroundSubarachnoid haemorrhage (SAH) and intraventricular haemorrhage (IVH) are associated with poor patient outcomes. Intraventricular fibrinolysis is effective in clearing IVH and improving patient survival and neurological outcome. By similar rationale, cisternal irrigation has been proposed as a potential method to accelerate haematoma clearance in SAH. We aimed to provide a comprehensive review and meta-analysis evaluating the effect of intraventricular and cisternal irrigation on clinical outcomes in patients with SAH and IVH.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed preparing this systematic review and study selection was performed by multiple investigators. We extracted ORs from the individual studies and aggregated these using a random effects model. The quality of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluations assessment and ROBINS-I or RoB-2.Results24 articles were included. In SAH, we found that cisternal irrigation with fibrinolytic agents was associated with reduced mortality (OR: 0.68, 95% CI 0.46 to 1.00), higher probability of favourable functional outcome (OR: 1.80, 95% CI 1.30 to 2.51), and reduced risks of DCI (OR: 0.28, 95% CI 0.18 to 0.42) and cerebral vasospasm (OR: 0.28, 95% CI 0.18 to 0.42), compared with conventional therapy. Cisternal irrigation with vasodilatory agents was associated with lower mortality (OR: 0.32, 95% CI 0.13 to 0.79) and reduced risk of cerebral vasospasm (OR: 0.37, 95% CI 0.17 to 0.79). The evidence for irrigation therapy of IVH was sparse and insufficient to show any significant effect.ConclusionIn this study, we found that cisternal irrigation could improve the prognosis in patients with SAH compared with conventional therapy. There is no evidence to support cisternal irrigation treatment of IVH.

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Section: Open Access Table 1 Summary Of Findings and Grade Assessmentmentioning

confidence: 99%

Cisternal and intraventricular irrigation in subarachnoid and intraventricular haemorrhage

Lind,

Krabbenhøft,

Valentin

et al. 2024

Stroke Vasc Neurol

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“…According to the previous study [8] , we de ned postoperative rehemorrhage as an increase in the hematoma volume of more than 33% compared to the previous postoperative CT scan, or reappearance of hyperdensity in the focal region at the follow-up CT scan after it was removed completely. Besides, hematoma clearance rate = (preoperative hematoma volume − postoperative hematoma volume) / preoperative hematoma volume [9] . Diagnoses of in-hospital complications were made by quali ed clinical practitioners according to the relevant guidelines.…”

Section: Data Collection and De Nition Of Variablesmentioning

confidence: 99%

Predicting the outcome of surgically treated patients with spontaneous intracerebral hemorrhage: a multicenter retrospective study

Huang

et al. 2023

Preprint

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Background and Purpose: Spontaneous intracerebral hemorrhage (ICH) is the deadliest type of stroke, and surgery is still one of the main treatment options for ICH. The aim of this study was to establish a prognostic model for surgically treated ICH patients. Methods: Data for this study were drawn from a national multicenter observational cohort study (ClinicalTrials identifier NCT03862729). Poor outcome was defined as modified Rankin Scale ≥ 4 at discharge. Overall survival (OS) was defined as the time from surgery to death or last follow-up. Multivariate logistic regression analysis was performed to identify significant variables associated with poor outcome. Associations of the variables with OS were assessed by Cox proportional hazard regression models. Prognostic scores were developed based on the regression coefficients. Receiver operating characteristic (ROC) curve analyses and the area under the ROC curve (AUC) were used to assess the predictive value of the model. Subgroup analyses were performed by splitting centers to assess the applicability of the two models. Results: Out of 1164 patients in the database, a total of 182 patients who met the inclusion criteria were included in this study. Preoperative Glasgow Coma Scale (GCS), deep ICH and presence of intraventricular hemorrhage were independent predictors of poor outcome. Age, preoperative GCS, presence of hydrocephalus and postoperative re-hemorrhage were independently associated with OS. Based on the results, two risk score models were established. The AUC of poor outcome risk (POR) score was 0.850 (95% CI 0.782 - 0.918) and the cut-off value was -0.982. 93.7% of patients identified as high-risk group had poor outcomes. The C-index of overall survival risk (OSR) score was 0.802 (95% CI 0.748-0.856). The Kaplan-Meier survival curves showed significantly (P < 0.001) lower survival probability in the high-risk group. Subgroup analyses showed no significant change in C-index and AUC values between groups. Conclusions: Our study proposed two new prognostic models for surgically treated ICH patients.

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Hemorrhagic Stroke: Endoscopic Aspiration

Feletti

Fiorindi

2022

Advances and Technical Standards in Neurosurgery

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Efficacy and safety profile of neuroendoscopic hematoma evacuation combined with intraventricular lavage in severe intraventricular hemorrhage patients

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 8 publications

References 16 publications

Cisternal and intraventricular irrigation in subarachnoid and intraventricular haemorrhage

Cisternal and intraventricular irrigation in subarachnoid and intraventricular haemorrhage

Predicting the outcome of surgically treated patients with spontaneous intracerebral hemorrhage: a multicenter retrospective study

Hemorrhagic Stroke: Endoscopic Aspiration

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