Intracerebral Hemorrhage With Severe Ventricular Involvement

Huttner, Hagen B.; Nagel, Simon; Tognoni, Elena; Köhrmann, Martin; Jüttler, Eric; Orakcioglu, Berk; Schellinger, Peter D.; Schwab, Stefan; Bardutzky, Jürgen

doi:10.1161/01.str.0000251795.02560.62

Cited by 79 publications

(73 citation statements)

References 14 publications

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“…12) A shunt procedure is required in 0% to 17% of cases after neuroendoscopy, 3,8,9,14) compared to 13.9% to 33% of cases after EVD. 6,7,10) However, whether neuroendoscopic surgery significantly reduces the incidence of communicating hydrocephalus remains unclear. In the present study, no patients required a shunt procedure after either endoscopic or non-endoscopic procedures, and no conclusions could be reached.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Outcomes of Intraventricular Hematoma Between Neuroendoscopic Removal and Extraventricular Drainage

Komatsu

Wakuta

et al. 2010

Neurol. Med. Chir.(Tokyo)

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The efficacy of treatment for intraventricular hematoma by neuroendoscopic surgery and extraventricular drainage was compared in 10 patients with intraventricular hematoma and hydrocephalus who underwent neuroendoscopic surgery (endoscopic group), and eight patients with intraventricular hematoma and hydrocephalus treated with extraventricular drainage (EVD group). The outcomes in each group were assessed retrospectively using the Graeb scores on the pre-and postoperative computed tomography (CT), duration of extraventricular drainage, requirement for a shunt operation, and modified Rankin scale score at 12 months. The Graeb scores on the preoperative CT were not significantly different between the two groups, but the duration of catheter placement was significantly shorter (69.3%) in the endoscopic group (2.7 days) than in the EVD group (8.8 days). None of the patients in either group required a shunt procedure for communicating hydrocephalus 12 months after surgery. Neuroendoscopic removal is a safe and effective procedure for intraventricular hematoma. Advantages include rapid removal of hematoma in the ventricular systems and reliable improvement of non-communicating hydrocephalus in the acute phase. The procedure resulted in faster removal of the catheter in the postoperative period and earlier patient ambulation.

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Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Outcomes of Intraventricular Hematoma Between Neuroendoscopic Removal and Extraventricular Drainage

Komatsu

Wakuta

et al. 2010

Neurol. Med. Chir.(Tokyo)

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“…8,12 EVD was then left closed for 24 hours. If there was no increase in ICP and no enlargement of the ventricular system on CT, the EVD was removed.…”

Section: Ld Managementmentioning

confidence: 99%

“…A major problem of communicating hydrocephalus is the need for prolonged external CSF drainage, thereby inhibiting early EVD removal. 8 Increasing duration of EVD, however, is associated with exponentially increasing the risk of ventriculitis. 9 Although there is no evidence supporting scheduled prophylactic EVD exchange, the latter is often practiced within institutional protocols as an attempt to reduce infection risk.…”

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confidence: 99%

“…11 In patients with communicating hydrocephalus, lumbar drainage (LD) may represent a simple and less invasive alternative for extracorporal CSF drainage with a lower complication profile compared with EVD. 8,12 Moreover, very early CSF drainage through LD may promote the circulation of newly formed CSF from the ventricles through the subarachnoid spaces, thereby promoting fast washout of potentially harmful blood. In a retrospective analysis of patients with secondary IVH with persisting malresorptive hydrocephalus, LD was capable to replace EVD, extend the duration of extracorporal CSF drainage, and eventually reduce the need for a permanent shunt.…”

mentioning

confidence: 99%

“…In a retrospective analysis of patients with secondary IVH with persisting malresorptive hydrocephalus, LD was capable to replace EVD, extend the duration of extracorporal CSF drainage, and eventually reduce the need for a permanent shunt. 8 The combined approach of IVF through EVD to reopen the ventricular system followed by early LD to replace EVD and to promote CSF circulation and washout of blood may represent a promising treatment algorithm with synergistic effects for severe IVH with initial obstructive and consecutive malresorptive hydrocephalus. 12 Therefore, the objective of this prospective study was to analyze the feasibility and safety of LD and its capability to replace EVD after the acute phase of IVF as soon as the third and fourth ventricles were cleared from blood and "EVD weaning" was unsuccessful.…”

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confidence: 99%

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Intraventricular Fibrinolysis and Lumbar Drainage for Ventricular Hemorrhage

Staykov

Huttner

Struffert

et al. 2009

Stroke

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Background and Purpose-Both intraventricular fibrinolysis (IVF) and lumbar drainage (LD) may reduce the need for exchange of external ventricular drainage (EVD) and shunt surgery in patients with intracerebral hemorrhage and severe intraventricular hemorrhage. We investigated the feasibility and safety of IVF followed by early LD for the treatment of posthemorrhagic hydrocephalus. Methods-This prospective study included patients with spontaneous ganglionic intracerebral hemorrhage and severe intraventricular hemorrhage with acute obstructive posthemorrhagic hydrocephalus who received an EVD (nϭ32). The treatment algorithm started with IVF (4 mg recombinant tissue plasminogen activator every 12 hours) until clearance of the third and fourth ventricles from blood. Thereupon, EVD was clamped and if clamping was unsuccessful, communicating posthemorrhagic hydrocephalus was assumed and LD placed. EVD was removed if there was neither an increase of intracranial pressure nor ventricle enlargement on CT. A ventriculoperitoneal shunt was indicated if "LD weaning" was unsuccessful for Ͼ10 days. Outcome was assessed at 90 and 180 days using the modified Rankin Scale. Results-IVF resulted in fast clearance of the third and fourth ventricles (73Ϯ50 hours). However, early EVD removal was only possible in 4 patients. The remaining 28 patients developed communicating posthemorrhagic hydrocephalus. In all of these patients, early LD was capable to replace EVD. EVD exchange was not necessary and EVD duration was 105Ϯ59 hours. Only one patient required a ventriculoperitoneal shunt. At 180 days, 20 (62.5%) patients had a good (modified Rankin Scale 0 to 3) outcome and 5 (15.6%) patients had died. One patient had asymptomatic ventricular rebleeding. Conclusions-In patients with secondary intraventricular hemorrhage and posthemorrhagic hydrocephalus, the combined treatment approach of IVF and early LD is safe and feasible, avoids EVD exchange, and may markedly reduce the need for shunt surgery.

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