Application of Neuroendoscopy in the Treatment of Intraventricular Hemorrhage

Zhang, Zaiqiang; Li, Xingang; Liu, Yuguang; Shao, Yongfu; Xu, Shujun; Yang, Yang

doi:10.1159/000103122

Cited by 62 publications

(70 citation statements)

References 45 publications

(23 reference statements)

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“…Thus, the primary goal of acute management for IVH should be the fast removal of intraventricular blood, rapid reversal of ventricular dilation, and normalization of ICP. All of these goals can be achieved immediately using the neuroendoscopic procedure, 16,25,26,36,37,51 while complications often observed with other traditional approaches are minimized. 33 …”

Section: Discussionmentioning

confidence: 99%

“…8,16,25,36,37,51 In all cases, efficient removal of intraventricular clots was rapidly achieved. However, in 2 of these reports, use of a rigid endoscope required either a cumbersome biportal approach 17 or an ultrasonic aspirator, 38 with a high risk (20%) of postoperative rebleeding.…”

Section: Endoscopic Aspirationmentioning

confidence: 94%

“…4,8,16,20,26,36,37,51 Intraventricular blood brings about multiple noxious effects 10,13 on the brain causing impairment of CSF circulation, 29 intracranial hypertension, 19 and acute 14 or delayed hydrocephalus. 15 Mortality estimates for IVH range from 50% to 80%.…”

mentioning

confidence: 99%

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External ventricular drainage alone versus endoscopic surgery for severe intraventricular hemorrhage: a comparative retrospective analysis on outcome and shunt dependency

Basaldella

Marton

Fiorindi

et al. 2012

FOC

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Object Massive intraventricular hemorrhages (IVHs) require aggressive and rapid management to decrease intracranial hypertension, because the amount of intraventricular blood is a strong negative prognostic predictor on outcome. Neuroendoscopy may offer some advantages over more traditional surgical approaches on outcome and may decrease the number of shunt procedures that need to be performed. Methods The authors retrospectively reviewed the clinical and radiological data in 96 patients treated for massive IVH who were admitted between January 1996 and June 2008 to the neurosurgery unit after undergoing emergency CT scanning. Forty-eight patients (Group A) were treated with endoscopic aspiration surgery using a flexible endoscope with a “freehand” technique. A historical group of 48 patients (Group B) treated using external ventricular drain (EVD) placement alone was used as a comparison. The authors compared the radiological results with the clinical outcomes at 1 year according to the modified Rankin Scale and the need for internal CSF shunt treatment in the 2 groups. Results Endoscopic aspiration did not significantly affect the outcome at 1 year as determined using the modified Rankin Scale. Patients who underwent endoscopy had an EVD in place for 0.18 days fewer than patients treated with an EVD alone. Patients undergoing external ventricular drainage alone had a 5 times greater chance of requiring a shunting procedure than those treated using neuroendoscopy and external ventricular drainage. Neuroendoscopy plus external drainage reduces shunting rates by 34% when compared with external drainage alone. Conclusions The reduction in internal shunt surgery encourages the adoption of neuroendoscopic aspiration of severe IVH as a therapeutic tool to decrease shunt dependency.

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Section: Discussionmentioning

confidence: 99%

Section: Endoscopic Aspirationmentioning

confidence: 94%

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External ventricular drainage alone versus endoscopic surgery for severe intraventricular hemorrhage: a comparative retrospective analysis on outcome and shunt dependency

Basaldella

Marton

Fiorindi

et al. 2012

FOC

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“…[220][221][222][223] A comparison of 48 patients with IVH secondary to ICH and other causes and treated with endoscopic removal of IVH found 17% required permanent CSF diversion compared with 50% of 48 historical control patients treated with VC alone. Outcome on the modified Rankin scale was similar.…”

Section: Strokementioning

confidence: 99%

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

Hemphill¹,

Greenberg²,

Anderson³

et al. 2015

Stroke

2,836

1,196

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2032Purpose-The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of spontaneous intracerebral hemorrhage. Methods-A formal literature search of PubMed was performed through the end of August 2013. The writing committee met by teleconference to discuss narrative text and recommendations. Recommendations follow the American Heart Association/American Stroke Association methods of classifying the level of certainty of the treatment effect and the class of evidence. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Oversight Committee and Stroke Council Leadership Committee. Results-Evidence-based guidelines are presented for the care of patients with acute intracerebral hemorrhage. Topics focused on diagnosis, management of coagulopathy and blood pressure, prevention and control of secondary brain injury and intracranial pressure, the role of surgery, outcome prediction, rehabilitation, secondary prevention, and future considerations. Results of new phase 3 trials were incorporated. Conclusions-Intracerebral hemorrhage remains a serious condition for which early aggressive care is warranted.These guidelines provide a framework for goal-directed treatment of the patient with intracerebral hemorrhage.

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“…However, only 2 small, prospective, RCTs evaluating endoscopic MIS are available to date. 43,44 Chen et al reported results on a population of 48 patients with thalamic hemorrhage and IVH, who were randomized 1:1 between either endoscopic-guided suction evacuation of IVH followed by EVD placement or EVD placement alone. In the endoscopic procedure, a standard suction tube was placed sideby-side with an endoscope through a rigid sheath to achieve evacuation of blood products from the ventricular system ipsilateral to the thalamic hemorrhage.…”

Section: Mechanically Based Mis For Ivhmentioning

confidence: 99%