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

Abstract

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

Application of neuroendoscopy in the treatment of obstructive hydrocephalus secondary to hypertensive intraventricular hemorrhage

“…Hence, the goal of management of IVH should thus be to evacuate IVH at the acute stage as much as possible. [8] Surgical methods of reducing hematoma volume and relieving obstruction to flow of CSF include placement of external ventricular drain (EVD) and stereotactic computed tomography (CT) guided aspiration with thrombolysis. [9,10] However, these procedures are associated with ventricular catheter obstruction, hemorrhage, procedure-related infection, and CSF pleocytosis.…”

“…[20] Several reports of use of various endoscopic procedures in the treatment of IVH with hydrocephalus with variable functional outcomes and mortality have been reported. [8,[13][14][15][16]21,22] Although, fiberscopes have been used in some reports, rigid endoscopes are commonly used because of the higher visual quality and ease in orientation. Yadav et al, [16] had demonstrated the safety of use of rigid scope in the management of severe IVH.…”

Neuroendoscopic evacuation of intraventricular hematoma associated with thalamic hemorrhage to shorten the duration of external ventricular drainage

“…On the other hand, patients with hydrocephalus caused by ventricular perforation of a thalamic hemorrhage are proven to benefit from treatment[252634] because severe IVH is associated with secondary brain damage owing to increased ICP, inflammation, and edema. In addition to its pathophysiological effects in the acute stage, IVH causes communicating hydrocephalus in the chronic stage.…”

“…Posthemorrhagic communicating hydrocephalus is usually ascribed to fibrosing arachnoiditis, which has been suggested to be caused by the increased deposition of extracellular matrix proteins because of the upregulation of transforming growth factor-beta (TGF-beta). [6] In order to maintain ICP, the patient’s stay in the intensive care unit is to be shortened,[13] the communicating hydrocephalus is prevented,[25] and the control of acute hydrocephalus and EVD of IVH is essential. The external ventricular drain gets easily obstructed by blood clots and carries a risk of infection.…”

Safety and feasibility of combined coiling and neuroendoscopy for better outcomes in the treatment of severe subarachnoid hemorrhage accompanied by massive intraventricular hemorrhage

“…4 Recently, some studies have reported that slow removal of the IVH through continuous ventricular drainage seems to be insufficient [5][6][7] and that radical removal of the IVH promotes better outcomes. [8][9][10] Here, we report on a series of patients with a severe SAH accompanied by a massive IVH who were treated with a combination of coiling the ruptured aneurysm and neuroendoscopically removing the blood from all ventricles between the lateral and the fourth ventricle.…”