“… 11 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 Nine clinical trial protocols were published in various clinical trial registries, of which four were published after 2017 but no study results available for any of these ongoing trials until the period of search for this review (January 1991 till June 2022). 8 , 9 , 10 , 30 , 31 , 32 , 33 , 34 , 35 All the principal investigators were contacted via email published for the details of these ongoing trials but details remained inaccessible. Fig.…”
“… 11 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 Nine clinical trial protocols were published in various clinical trial registries, of which four were published after 2017 but no study results available for any of these ongoing trials until the period of search for this review (January 1991 till June 2022). 8 , 9 , 10 , 30 , 31 , 32 , 33 , 34 , 35 All the principal investigators were contacted via email published for the details of these ongoing trials but details remained inaccessible. Fig.…”
“…63 However, a randomized double-blinded trial comparing EVD (Control group) and ES + IVF (Intervention group) had preliminary results showing higher 180-day mRS scores (95% CI 1.0-2.2, P = 0.004) for ES + IVF group and also had a lower mortality rate 9.1% as compared to 25.5% among the EVD group, however, the trial was terminated prematurely due to high mortality rate in the control arm. 64 A network meta-analysis exploring the efficacy and safety of interventions for IVH concluded that ES is optimal for IVH as it improved survival and prognosis and also reduced VP shunt rate, intracranial rebleeding, and infection risk. 65 Finally, the current evidence on this modality constitutes only preliminary data and further investigation is warranted.…”
Intraventricular hemorrhage (IVH) is a clinical challenge observed among 40–45% of intracerebral hemorrhage (ICH) cases. IVH can be classified according to the source of the hemorrhage into primary and secondary IVH. Primary intraventricular hemorrhage (PIVH), unlike secondary IVH, involves only the ventricles with no hemorrhagic parenchymal source. Several risk factors of PIVH were reported which include hypertension, smoking, age, and excessive alcohol consumption. IVH is associated with high mortality and morbidity and several prognostic factors were identified such as IVH volume, number of ventricles with blood, involvement of fourth ventricle, baseline Glasgow Coma Scale score, and hydrocephalus. Prompt management of patients with IVH is required to stabilize the clinical status of patients upon admission. Nevertheless, further advanced management is crucial to reduce the morbidity and mortality associated with intraventricular bleeding. Recent treatments showed promising outcomes in the management of IVH patients such as intraventricular anti-inflammatory drugs, lumbar drainage, and endoscopic evacuation of IVH, however, their safety and efficacy are still in question. This literature review presents the epidemiology, physiopathology, risk factors, and outcomes of IVH in adults with an emphasis on recent treatment options.
“…[7][8][9][10][11] In patients with obstructive hydrocephalus, who had been given temporary CSF diversion with an external ventricular drainage (EVD), not all of them will progress to shunt-dependent hydrocephalus. [12][13][14][15] As the hematoma that blocked the CSF ow lyse, other mechanisms have been proposed that could cause shunt-dependent hydrocephalus, such as ferroptosis, in ammation of the ventricular system, and other unknown mechanisms. [16][17][18] Based on this theory, we hypothesize that the amount of intraventricular hematoma, levels of CSF iron, and in ammatory proteins will be signi cantly associated with the risk of shunt-dependent hydrocephalus in ICH + IVH + HCP patients.…”
Background
Hydrocephalus (HCP) is a known complication of spontaneous intracerebral hemorrhage (ICH) extension into the ventricles (IVH) and is associated with poorer patient outcomes. The mechanisms in HCP development are not yet clear. Biomarkers in CSF could predict the risk of shunt-dependent hydrocephalus, to improve clinical outcomes in these patients, and could be more reliable than CT-scan evaluation.
Aim
This study aimed to test the reliability of measuring Fe2+, Fe3+, total iron concentration, and high mobility group box 1 (HMGB1) protein levels as CSF biomarkers to predict the risk of shunt-dependent hydrocephalus in ICH + IVH patients. We compared marker reliability with CT-scan mGraeb score to predict hydrocephalus.
Methods
All adult ICH + IVH patients with hydrocephalus admitted to Siloam Hospitals Lippo Village between March 2021 until December 2023 were included in this cohort study. The patient's clinical and radiological characteristics were retrieved, and CSF samples were obtained during EVD placement. Statistical analyses were performed to reveal potential clinical, radiological, and biomarker values as predictors of shunt-dependent hydrocephalus in ICH + IVH patients.
Results
Thirty-six ICH + IVH + HCP patients, including 16 females (44.4%) and 20 males (55.6%) were included in this study, with mean age of 60.75 years. Seventeen patients (47.2%) were diagnosed with shunt-dependent hydrocephalus. Logistic regression analyses revealed that increased total Fe (p = 0.048) and Fe2+ (0.045) were significantly associated with the incidence of shunt-dependent hydrocephalus. Receiver operating curves (ROC) revealed that the AUCs from total iron (0.716), Fe2+ (0.758), Fe3+ (0.651), and HMGB1 (0.722) are higher than the AUC of mGraeb score (0.528).
Conclusion
Based on the results from logistic regression analyses and constructed ROCs, CSF total iron and Fe2+ are reliable prognosticators of shunt-dependent hydrocephalus in ICH + IVH + HCP patients. These biomarkers are more sensitive and specific in predicting hydrocephalus compared to mGraeb score.
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