Endoscopic Evacuation of Massive Intraventricular Hemorrhages Reduces Shunt Dependency: A Meta-Analysis

Abstract

Intraventricular hemorrhage (IVH) is characterized by severe prognosis. The amount of intraventricular blood is the most important, disease-specific, prognostic factor, as acute complications are strictly dependent on clot formation. Although external ventricular drain (EVD) placement is the standard treatment, in the past 15 years neuroendoscopic (NE) evacuation of IVH has been advocated, but available comparative data are limited. A systematic review of the literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles compare the treatment of primary and secondary IVH with NE and EVD. The meta-analysis was performed in terms of shunt dependency. Cochran's Q-test and I2 statistics were used to assess heterogeneity in the studies. No heterogeneity was considered for p greater than 0.05 and I2 less than 20%. A random-effect model was used, with restricted maximum likelihood to estimate the heterogeneity variance. After screening 744 articles, 5 were included in the meta-analysis. A total of 303 patients presenting with primary or pure (50 patients) and secondary (253 patients) IVH, undergoing either NE (151) or EVD (152), were included in the metanalysis. The risk of ventriculoperitoneal (VP) shunt was higher in the EVD group (relative risk: 1.93, 95% confidence interval: 1.28–2.92, p = 0.0094). The risk of VP shunt was higher in the EVD group, but the overall outcome remains poor for patients with IVH, with a moderate-to-high disability. Large randomized controlled trials are needed to evaluate more deeper both advantages and effects on the outcome of NE over EVD.

Neuroradiological Correlation of the Lateral Third Periventricular, Pituitary Gland and Stalk, Pineal Gland, Cerebral Aqueduct, and Foramen Magendie and Luschka With Intraventricular Neuroendoscopic Images: A Case Series

“…As time progresses, the neuroinflammatory process further damages the ependymal layer of the ventricles, resulting in discontinuity of the surface, gliosis, and scarring [ 24 , 25 ]. One way of preventing this is via an endoscopic washout of the hematoma, which allows the clearing of the blood products that are obstructing the ventricular channel (Figure 7 ) and, in the future, reduces the permanent VPS dependency [ 26 ].…”

“…In this collection, the authors look at different cases and try to appreciate the neuroendoscopic images and correlate them with radiological imaging. For example, in selected cases such as ETV, this avoids the use of CSF diversion such as permanent ventriculoperitoneal shunt or temporary external ventricular drain to treat hydrocephalus [ 26 ]. Some cases are considered straightforward but some require a great understanding of underlying clinical history.…”

The long-term effect on functional outcome of endoscopic brainwashing for intraventricular hemorrhage compared to external ventricular drainage alone: A retrospective single-center cohort study

“…We encourage new studies to use the mGS, which is more closely related to IVH volume and outcome than the Graeb score. [ 10 ]…”

“…We encourage new studies to use the mGS, which is more closely related to IVH volume and outcome than the Graeb score. [10] Studies that reported the outcome after neuroendoscopic surgery showed a favorable outcome, measured by the Glasgow Outcome Scale (GOS). [7,21,30] When comparing neuroendoscopic and EVD placement, some studies did not show any difference in mRS at six months [36] or GOS at three months, [31] despite some demonstrating a tendency of better outcome with endoscopic washout.…”