Neuroendoscopic Removal of Intraventricular Hemorrhage Combined with Hydrocephalus

Abstract

Objective: The neuroendoscope is playing an increasing role in the diagnosis and treatment of several types of lesions, in particular in the ventricular system. Hydrocephalus associated with intraventricular hemorrhage (IVH) is a good indication for neuroendoscopic surgery. We describe herein our experiences with 17 cases of IVH combined with hydrocephalus treated using a neuroendoscope.

Patients and Methods: The subjects comprised 17 patients with IVH combined with hydrocephalus treated in our department, including cases of thalamic hemorrhage (n=10), caudate hemorrhage (n=5), moya-moya disease (n=1), and dural arteriovenous fistula (n=1). We used a flexible fiberscope that was inserted into the anterior horn of the lateral ventricle. Hematoma was easily evacuated through the working channel of the neuroendoscope by manual maneuvers. Hematomas in the third ventricle, aqueduct and fourth ventricle could also be evacuated. With the addition of septostomy, hematomas in the contralateral lateral ventricle could also be evacuated.

Results: All patients underwent successful procedures with good outcomes. No permanent morbidity and mortality was associated with any neuroendoscopic procedures. Shunt insertion was required in 3 cases due to malabsorption of cerebrospinal fluid (CSF) in the chronic stage.

Conclusions: Neuroendoscopic procedures with a flexible fiberscope for the removal of IVH allow resolution of the disturbed CSF circulation. This procedure improves the safety and accuracy of treatment for IVH combined with hydrocephalus.

Key words

intraventricular hemorrhage - neuroendoscope - hydrocephalus

References

• 1 Diringer MN, Edwards DF, Zazulia AR. Hydrocephalus: a previously unrecognized predictor of poor outcome from supratentorial intracerebral hemorrhage.  Stroke. 1998;  29 1352-1357
• 2 Graeb DA, Robertson WD, Lapointe JS. et al . Computed tomographic diagnosis of intraventricular hemorrhage: etiology and prognosis.  Radiology. 1982;  143 91-96
• 3 Logatti PL, Martinuzzi A, Fiorindi A. et al . Neuroendoscopic management of intraventricular hemorrhage.  Stroke. 2004;  35 e35-e38
• 4 Hamada H, Hayashi N, Kurimoto M. et al . Neuroendoscopic septostomy for isolated lateral ventricle.  Neuro Med Chir. 2003;  43 582-588
• 5 Hayashi N, Endo S, Hamada H. et al . Endoscopic evacuation of thalamic hemorrhage associated with intraventricular hemorrhage.  Surg Cereb Stroke (Jpn). 1999;  27 110-114
• 6 Tuhrim S, Horowitz DR, Saccher M. et al . Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage.  Crit Care Med. 1999;  27 617-621
• 7 Hayashi N, Nishimura S, Numagami Y. et al . Retrospective analysis of effects and complications in cases treated with endoscopic evacuation of intracerebral hemorrhage.  No Shinkei Geka. 2006;  34 1233-1238
• 8 Hsieh PC. Endoscopic removal of thalamic hematoma: a technical note.  Minim Invas Neurosurg. 2006;  46 369-371
• 9 Nakano T, Ohkuma H, Ebina K. et al . Neuroendoscopic surgery for intracerebral hemorrhage-comparison with traditional therapies.  Minim Invas Neurosurg. 2006;  46 278-283
• 10 Nishihara T, Nagata K, Takeda J. et al . Endoscopic evacuation of hypertensive intracerebral hemorrhage. The importance of hemostasis in ultra-early surgery.  Jpn J Neurosurg (Tokyo). 2005;  14 401-406
• 11 Barbagallo GMV, Platania N, Schonauer C. Long-term resolution of acute, obstructive, triventricular hydrocephalus by endoscopic removal of a third ventricular hematoma without third ventriculostomy. Case report and review of the literature.  J Neurosurg. 2005;  102 930-934
• 12 Longatti P, Fiorindi A, Paola F Di. et al . Coiling and neuroendoscopy: a new perspective in the treatment of intraventricular hemorrhages due to bleeding aneurysms.  J Neurol Neurosurg Psychiatry. 2006;  77 1354-1358
• 13 Longatti P, Fiorindi A, Martinuzzi A. Neuroendoscopic aspiration of hematocephalus totalis: Technical note.  Neurosurgery. 2005;  57 ((4 Suppl)) E409
• 14 Yadav YR, Mukerji G, Shenoy R. et al . Endoscopic management of hypertensive intraventricular hemorrhage with obstructive hydrocephalus.  BMC Neurology. 2007;  7 1
• 15 Hayashi N, Hamada H, Umemura K. et al . Transparent endoscopic sheath and rigid-rod endoscope used in endoscopic third ventriculostomy for hydrocephalus in the presence of deformed ventricular anatomy.  J Neurosurg. 2006;  104 321-325

Correspondence