Single versus bilateral external ventricular drainage for intraventricular fibrinolysis using urokinase in severe ventricular haemorrhage

Du, Bo; Wang, Jin; Zhong, Xiaohong; Liang, Jian; Xiang, Wei; Dong, Chen; Lv, Wen; Shan, Aijun

doi:10.3109/02699052.2014.916821

Cited by 13 publications

(7 citation statements)

References 8 publications

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“…32,33 We should also keep in mind that the use of two EVDs plus a longer duration increases the risk for complications, especially for infection. 27,29,30,34 As mentioned above, higher age is related to a higher IVH volume reduction. On the other hand, higher age is found by some to be the most important predictor for poor outcome among other independent predictors such as hemorrhage size (if IVH is caused by an ICH) and intraventricular spread of hemorrhage.…”

Section: Discussionmentioning

confidence: 84%

Postoperative Reduction of Intraventricular Hemorrhage Volume: Single- Versus Dual-Catheter Drainage

Hussain

Raza

Shahid

et al. 2018

J Neurol Surg A Cent Eur Neurosurg

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Section: Discussionmentioning

confidence: 84%

Postoperative Reduction of Intraventricular Hemorrhage Volume: Single- Versus Dual-Catheter Drainage

Hussain

Raza

Shahid

et al. 2018

J Neurol Surg A Cent Eur Neurosurg

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“…Because this minimally invasive surgery primarily occurs only in the hematoma cavity, it can effectively remove the hematoma and avoid direct contact with ruptured blood vessels and surrounding brain tissues; furthermore, by combining hematoma aspiration with biochemical enzyme technology to rinse, liquefy, and drain the hematoma cavity, not only can the hematoma be cleared and the intracranial pressure be reduced but also intracellular cytotoxic substances can be diluted and antagonized, which can reduce the occurrence of secondary brain edema, restore the blood supply for the brain tissue in the para-hematoma ischemic penumbra, and protect the para-wound brain tissue, maximally protecting nerve function. 16,17 Traditional stereotactic surgery generally utilizes one head frame to implement positioning, which can cause pain and fear in patients;…”

Section: Figurementioning

confidence: 99%

Neurosurgery medical robot Remebot for the treatment of 17 patients with hypertensive intracerebral hemorrhage

Wang

Zhao

et al. 2019

Robotics Computer Surgery

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Objective To verify the minimally invasive surgical approach and therapeutic effects of using the medical neurosurgery robot Remebot to treat hypertensive intracerebral hemorrhage (HICH). Methods Clinical data for 17 HICH patients were analyzed retrospectively. Hematoma evacuation and tube drainage using Remebot frameless stereotaxic techniques were performed for all patients, and urokinase was injected into the hematomas after the operations. Results Robot‐assisted stereotactic techniques can accurately guide hematoma punctures, and no deaths occurred among these patients. The average positioning error was 1.28 ± 0.49 mm. The average drainage duration was 3.4 days. The 3‐month postoperative follow‐up revealed improved neurological functions and quality of life for all patients. Conclusions The medical neurosurgery robot Remebot is minimally invasive, has high positional accuracy, and facilitates surgical planning according to the shape of the hematoma. Therefore, robot‐assisted surgery using Remebot represents a safe and effective treatment method for hematoma evacuation and tube drainage in HICH patients.

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“…5) who were randomized to placement of one or two EVDs and reported significantly faster drainage of IVH volume with two EVDs compared with one, together with IVF and no incidence of rehemorrhage or infection. 66 A second strategy to improve clot removal efficiency is EVD placement position. In a post hoc analysis of data from the CLEAR III trial, clinically meaningful 85% IVH volume reduction was independently associated with smaller IVH volume, younger age, and placement of ventricular drainage catheters ipsilateral to the dominant IVH volume, adjusting for alteplase treatment.…”

Section: Enhancing Clot Lysis and Removalmentioning

confidence: 99%

Spontaneous Intraventricular Hemorrhage: When Should Intraventricular tPA Be Considered?

Abdelmalik

Ziai

2017

Semin Respir Crit Care Med

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Spontaneous intracerebral hemorrhage (ICH) is the most common cause of intraventricular hemorrhage (IVH) in adults. Complicating approximately 40% of ICH cases, IVH adds to the morbidity and mortality of this often fatal form of stroke. It is also a severity factor that complicates subarachnoid hemorrhage and traumatic brain injury, along with other less common causes of intracranial bleeding. Medical and surgical interventions to date have focused on limiting ICH and IVH expansion, controlling intracranial pressure, and relieving obstructive hydrocephalus. The placement of an external ventricular drain (EVD) can achieve the latter two goals but has not demonstrated improvement in clinical outcomes beyond mortality reduction. More recently, intraventricular fibrinolysis, utilizing the EVD, has gained interest as a safe and potentially effective method to maintain catheter patency and facilitate hematoma removal. A recent phase III clinical trial evaluating the efficacy of intraventricular alteplase versus intraventricular saline showed a mortality benefit, but failed to meet the primary endpoint of significant functional improvement. However, planned subgroup analysis focusing on patients with IVH volume > 20 mL, and those with IVH removal > 85% suggest that significant functional benefits may be attainable with this therapy. The practice of intraventricular fibrinolysis for spontaneous IVH is not the standard of care; however, based on 20 years of experience, it meets thresholds as a safe intervention, and in those patients with a high burden of intraventricular blood, aggressive clearance may lead to improved quality of life in survivors of this morbid syndrome.

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Single versus bilateral external ventricular drainage for intraventricular fibrinolysis using urokinase in severe ventricular haemorrhage

Abstract: The results provide some evidence to support the use of bilateral EVDs for IVF in patients with severe IVH.

Cited by 13 publications

References 8 publications

Postoperative Reduction of Intraventricular Hemorrhage Volume: Single- Versus Dual-Catheter Drainage

Postoperative Reduction of Intraventricular Hemorrhage Volume: Single- Versus Dual-Catheter Drainage

Neurosurgery medical robot Remebot for the treatment of 17 patients with hypertensive intracerebral hemorrhage

Spontaneous Intraventricular Hemorrhage: When Should Intraventricular tPA Be Considered?

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