Delayed Endoscopic Intraventricular Hemorrhage (IVH) Removal and Endoscopic Third Ventriculostomy May Not Prevent Consecutive Communicating Hydrocephalus if IVH Removal was Insufficient

Abstract

Object: The aim of this study was to investigate whether delayed endoscopic treatment of intraventricular hemorrhage (IVH) can prevent consecutive communicating hydrocephalus.

Methods: A retrospective series of 9 patients with IVH caused by intracerebral hemorrhage (ICH) who were treated with external ventricular drainage (EVD) or endoscopic IVH removal and endoscopic third ventriculostomy (ETV) was studied in our institute. Five of these patients who had previously been treated a year before in our institute with the installation of a flexible endoscope, were treated with EVD alone on admission. Of the other patients, three received endoscopic removal of IVH and ETV and, after a one week, EVD placement, and the final patient underwent endoscopic IVH removal and ETV one day after onset.

Results: Three of the patients treated with EVD alone were fitted with the EVD for 8, 11 and 16 days, and 2 patients were fitted with the EVD until they died. No patients treated with EVD alone required shunt placement. In contrast, of the 4 patients treated endoscopically, EVD was placed totally for 0, 6, 9, and 22 days for each patient, among whom 2 patients required shunt placement.

Conclusions: Delayed endoscopic IVH removal and ETV might not prevent consecutive communicating hydrocephalus if IVH removal was insufficient.

intraventricular hemorrhage - intracerebral hemorrhage - endoscope - hydrocephalus

References

• 1 Adams RE, Diringer MN. Response to external ventricular drainage in spontaneous intracerebral hemorrhage with hydrocephalus.  Neurology. 1998;  50 519-523
• 2 Liliang PC, Liang CL, Lu CH, Chang HW, Cheng CH, Lee TC, Chen HJ. Hypertensive caudate hemorrhage prognostic predictor, outcome, and role of external ventricular drainage.  Stroke. 2001;  32 1195-1200
• 3 Kiymaz N, Demir O, Cirak B. Is external ventricular drainage useful in primary intraventricular hemorrhages?.  Adv Ther. 2005;  22 447-452
• 4 Sumer MM, Acikgoz B, Akpinar G. External ventricular drainage for acute obstructive hydrocephalus developing following spontaneous intracerebral haemorrhages.  Neurol Sci. 2002;  23 29-33
• 5 Phan TG, Koh M, Vierkant RA, Wijdicks EF. Hydrocephalus is a determinant of early mortality in putaminal hemorrhage.  Stroke. 2000;  31 2157-2162
• 6 Diringer MN, Edwards DF, Zazulia AR. Hydrocephalus: a previously unrecognized predictor of poor outcome from supratentorial intracerebral hemorrhage.  Stroke. 1998;  29 1352-1357
• 7 Broderick JP, Brott TG, Duidner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality.  Stroke. 1993;  24 987-993
• 8 Mayfrank L, Kissler J, Raoofi R, Delsing P, Weis J, Kuker W, Gilsbach JM. Ventricular dilatation in experimental intraventricular hemorrhage in pigs. Characterization of cerebrospinal fluid dynamics and the effects of fibrinolytic treatment.  Stroke. 1997;  28 141-148
• 9 Lodhia KR, Shakui P, Keep RF. Hydrocephalus in a rat model of intraventricular hemorrhage.  Acta Neurochir Suppi. 2006;  96 207-211
• 10 Pang D, Sciabassi RJ, Horton JA. Lysis of intraventricular blood clot with urokinase in a canine model: Part 3. Effects of intraventricular urokinase on clot lysis and posthemorrhagic hydrocephalus.  Neurosurgery. 1986;  19 553-572
• 11 Wieser HG, Probst C. Clinical observations on hydrocephalus with special regard to the posttraumatic malresorptive form (author's transl).  J Neurol. 1976;  212 1-21
• 12 Fuentes S, Maetellus P, Dufour H, Bruder N, Do L, N’Doye N, Grisoli F. Endoscopic third ventriculostomy for management of obstructive hydrocephalus secondary to supratentorial intraventricular hematoma. Case report.  Neurochirurgie. 2002;  48 510-515
• 13 Huttner HB, Nagel S, Tognoni E, Kohrmann M, Juttler E, Orakcioglu B, Schellinger PD, Schwab S, Bardutzky J. Intracerebral hemorrhage with severe ventricular involvement: lumbar drainage for communicating hydrocephalus.  Stroke. 2007;  38 183-187
• 14 Lo CH, Spelman D, Bailey M, Cooper DJ, Rosenfeld JV, Brecknell JE. External ventricular drain infections are independent of drain duration: an argument against elective revision.  J Neurosurg. 2007;  106 378-383
• 15 Todo T, Usui M, Takakura K. Treatment of severe intraventricular hemorrhage by intraventricular infusion of urokinase.  J Neurosurg. 1991;  74 81-86
• 16 Naff NJ, Hanley DF, Keyl PM, Tuhrim S, Kraut M, Bederson J, Bullock R, Mayer SA, Schmutzhard E. Intraventricular thrombolysis speeds blood clot resolution: results of a pilot, prospective, randomized, double-blind, controlled trial.  Neurosurgery. 2004;  54 577-583 , discussion 583-574
• 17 Holtzman RN, Brust JC, Ainyette IG, Bowers PP, Tikofsky RS, Lliguin HM, Hughes JE. Acute ventricular hemorrhage in adults with hydrocephalus managed by corpus callosotomy and fenestration of the septum pellucidum. Report of three cases.  J Neurosurg. 2001;  95 111-115
• 18 Anzai K, Kamiyama K, Sasaki T, Nakamura H. Endoscopic evacuation of intraventricular hematoma and third ventriculostomy.  No Shinkei Geka. 2000;  28 599-605
• 19 Yadav YR, Mukerji C, Shenoy R, Basoor A, Jam G, Nelson A. Endoscopic management of hypertensive intraventricular haemorrhage with obstructive hydrocephalus.  BMC Neurol. 2007;  7 1
• 20 Nishihara T, Nagata K, Tanaka S, Suzuki Y, Izumi M, Mochizuki Y, Akabane A, Ochiai C. Newly developed endoscopic instruments for the removal of intracerebral hematoma.  Neurocrit Care. 2005;  2 67-74
• 21 Barbagallo GM, 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

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