“…Clinical outcome were similar in two strategies. Also, this is the first study investigating the effect of catheter location of EVD on patients’ outcome Xia et al, 2014 [ 18 ] China Prospective Single-center 8 68 EVD and early CLD 6 GOS 3.62 13 First prospective study providing insight into the safety, feasibility, and potential benefit of combining early CLD with EVD in moderate to severe IVH regardless of the presence of obstructive hydrocephalus Obaid et al, 2015 [ 19 ] Cananda Retrospective Single-center 8 58 Endoscopic removal of hematoma and ETV for hydrocephalus 21.3 mRS 3.5 37.5 ETV with or without endoscopic clot evacuation is a safe and effective method to treat IVH-related obstructive hydrocephalus Ogiwara et al, 2021 [ 20 ] Japan Retrospective Multi-center 8 54.4 Endoscopic removal of hematoma and ETV for hydrocephalus At discharge mRS 3 0 Tailor-made endoscopic strategy revealed a good hematoma evacuation rate and potential for improved functional outcome EVD external ventricular hemorrhage, GOS Glasgow Outcome Scale, ETV endoscopic third ventriculostomy, mRS modified Rankin Scale, IVF intraventricular fibrinolysis, LD lumber drainage, CLD continuous lumber drainage Fig. 1 Flow-gram of the study …”
Section: Resultsmentioning
confidence: 99%
“…Of these nine studies, four took place in China [ 13 , 17 , 18 , 21 ], two in Japan [ 15 , 20 ], one in Canada [ 19 ], one in Germany [ 16 ], and one each in India and the UK [ 14 ]. Four studies were prospective cohort studies [ 13 , 14 , 16 , 18 ], three were retrospective cohort studies [ 15 , 19 , 20 ], and two were randomized controlled studies [ 17 , 21 ]. Six studies were performed at a single center [ 13 , 15 – 18 , 22 ], while three were multi-center studies [ 14 , 20 , 21 ].…”
Section: Resultsmentioning
confidence: 99%
“…In total, 207 patients were included in the review. The modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS) were the two outcome measurements used in all nine studies: the GOS was used in five studies [ 13 , 14 , 17 , 18 , 21 ], while the mRS was used in four [ 15 , 16 , 19 , 20 ].…”
Section: Resultsmentioning
confidence: 99%
“…One randomized controlled study [ 17 ] was rated as having some concerns in the domain of selection of the reported result, while the other randomized controlled study [ 21 ] was deemed low risk. Five [ 13 , 14 , 16 , 18 , 19 ] cohort studies were of good quality, one [ 20 ] was of fair quality, and one [ 15 ] was of poor quality due to the outcome domain.…”
Section: Resultsmentioning
confidence: 99%
“…Five [ 13 , 14 , 16 , 18 , 19 ] cohort studies were of good quality, one [ 20 ] was of fair quality, and one [ 15 ] was of poor quality due to the outcome domain.…”
Background
Intraventricular hemorrhage (IVH) refers to bleeding within the brain’s ventricular system, and hydrocephalus is a life-threatening complication of IVH characterized by increased cerebrospinal fluid accumulation in the ventricles resulting in elevated intracranial pressure. IVH poses significant challenges for healthcare providers due to the complexity of the underlying pathophysiology and lack of standardized treatment guidelines. Herein, we performed a systematic review of the treatment strategies for hydrocephalus secondary to IVH.
Methods
This systematic review was prospectively registered with PROSPERO (CRD42023450786). The search was conducted in PubMed, Cochrane Library, and Web of Science on July 15, 2023. We included original studies containing valid information on therapy management and outcome of hydrocephalus secondary to primary, spontaneous, and subarachnoid or intracranial hemorrhage following IVH in adults that were published between 2000 and 2023. Glasgow Outcome Scale (GOS) or modified Ranking Scale (mRS) scores during follow-up were extracted as primary outcomes. The risk of bias was assessed using the Newcastle–Ottawa Scale for Cohort Studies or Cochrane Risk of Bias 2.0 Tool.
Results
Two hundred and seven patients from nine published papers, including two randomized controlled trials, were included in the analysis. The GOS was used in five studies, while the mRS was used in four. Seven interventions were applied, including craniotomy for removal of hematoma, endoscopic removal of hematoma with/without endoscopic third ventriculostomy (ETV), traditional external ventricular drainage (EVD), and various combinations of EVD, lumbar drainage (LD), and intraventricular fibrinolysis (IVF). Endoscopic removal of hematoma was performed in five of nine studies. Traditional EVD had no obvious benefit compared with new management strategies. Three different combinations of EVD, LD, and IVF demonstrated satisfactory outcomes, although more studies are required to confirm their reliability. Removal of hematoma through craniotomy generated reliable result. Generally, endoscopic removal of hematoma with ETV, removal of hematoma through craniotomy, EVD with IVF, and EVD with early continuous LD were useful.
Conclusion
EVD is still crucial for the management of IVH and hydrocephalus. Despite a more reliable result from the removal of hematoma through craniotomy, a trend toward endoscopic approach was observed due to a less invasive profile.
“…Clinical outcome were similar in two strategies. Also, this is the first study investigating the effect of catheter location of EVD on patients’ outcome Xia et al, 2014 [ 18 ] China Prospective Single-center 8 68 EVD and early CLD 6 GOS 3.62 13 First prospective study providing insight into the safety, feasibility, and potential benefit of combining early CLD with EVD in moderate to severe IVH regardless of the presence of obstructive hydrocephalus Obaid et al, 2015 [ 19 ] Cananda Retrospective Single-center 8 58 Endoscopic removal of hematoma and ETV for hydrocephalus 21.3 mRS 3.5 37.5 ETV with or without endoscopic clot evacuation is a safe and effective method to treat IVH-related obstructive hydrocephalus Ogiwara et al, 2021 [ 20 ] Japan Retrospective Multi-center 8 54.4 Endoscopic removal of hematoma and ETV for hydrocephalus At discharge mRS 3 0 Tailor-made endoscopic strategy revealed a good hematoma evacuation rate and potential for improved functional outcome EVD external ventricular hemorrhage, GOS Glasgow Outcome Scale, ETV endoscopic third ventriculostomy, mRS modified Rankin Scale, IVF intraventricular fibrinolysis, LD lumber drainage, CLD continuous lumber drainage Fig. 1 Flow-gram of the study …”
Section: Resultsmentioning
confidence: 99%
“…Of these nine studies, four took place in China [ 13 , 17 , 18 , 21 ], two in Japan [ 15 , 20 ], one in Canada [ 19 ], one in Germany [ 16 ], and one each in India and the UK [ 14 ]. Four studies were prospective cohort studies [ 13 , 14 , 16 , 18 ], three were retrospective cohort studies [ 15 , 19 , 20 ], and two were randomized controlled studies [ 17 , 21 ]. Six studies were performed at a single center [ 13 , 15 – 18 , 22 ], while three were multi-center studies [ 14 , 20 , 21 ].…”
Section: Resultsmentioning
confidence: 99%
“…In total, 207 patients were included in the review. The modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS) were the two outcome measurements used in all nine studies: the GOS was used in five studies [ 13 , 14 , 17 , 18 , 21 ], while the mRS was used in four [ 15 , 16 , 19 , 20 ].…”
Section: Resultsmentioning
confidence: 99%
“…One randomized controlled study [ 17 ] was rated as having some concerns in the domain of selection of the reported result, while the other randomized controlled study [ 21 ] was deemed low risk. Five [ 13 , 14 , 16 , 18 , 19 ] cohort studies were of good quality, one [ 20 ] was of fair quality, and one [ 15 ] was of poor quality due to the outcome domain.…”
Section: Resultsmentioning
confidence: 99%
“…Five [ 13 , 14 , 16 , 18 , 19 ] cohort studies were of good quality, one [ 20 ] was of fair quality, and one [ 15 ] was of poor quality due to the outcome domain.…”
Background
Intraventricular hemorrhage (IVH) refers to bleeding within the brain’s ventricular system, and hydrocephalus is a life-threatening complication of IVH characterized by increased cerebrospinal fluid accumulation in the ventricles resulting in elevated intracranial pressure. IVH poses significant challenges for healthcare providers due to the complexity of the underlying pathophysiology and lack of standardized treatment guidelines. Herein, we performed a systematic review of the treatment strategies for hydrocephalus secondary to IVH.
Methods
This systematic review was prospectively registered with PROSPERO (CRD42023450786). The search was conducted in PubMed, Cochrane Library, and Web of Science on July 15, 2023. We included original studies containing valid information on therapy management and outcome of hydrocephalus secondary to primary, spontaneous, and subarachnoid or intracranial hemorrhage following IVH in adults that were published between 2000 and 2023. Glasgow Outcome Scale (GOS) or modified Ranking Scale (mRS) scores during follow-up were extracted as primary outcomes. The risk of bias was assessed using the Newcastle–Ottawa Scale for Cohort Studies or Cochrane Risk of Bias 2.0 Tool.
Results
Two hundred and seven patients from nine published papers, including two randomized controlled trials, were included in the analysis. The GOS was used in five studies, while the mRS was used in four. Seven interventions were applied, including craniotomy for removal of hematoma, endoscopic removal of hematoma with/without endoscopic third ventriculostomy (ETV), traditional external ventricular drainage (EVD), and various combinations of EVD, lumbar drainage (LD), and intraventricular fibrinolysis (IVF). Endoscopic removal of hematoma was performed in five of nine studies. Traditional EVD had no obvious benefit compared with new management strategies. Three different combinations of EVD, LD, and IVF demonstrated satisfactory outcomes, although more studies are required to confirm their reliability. Removal of hematoma through craniotomy generated reliable result. Generally, endoscopic removal of hematoma with ETV, removal of hematoma through craniotomy, EVD with IVF, and EVD with early continuous LD were useful.
Conclusion
EVD is still crucial for the management of IVH and hydrocephalus. Despite a more reliable result from the removal of hematoma through craniotomy, a trend toward endoscopic approach was observed due to a less invasive profile.
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