Effectiveness of Combined External Ventricular Drainage with Intraventricular Fibrinolysis for the Treatment of Intraventricular Haemorrhage with Acute Obstructive Hydrocephalus

Abstract

Background: Intraventricular haemorrhage (IVH) patients with acute obstructive hydrocephalus (AOH) who require external ventricular drainage (EVD) are at high risk for poor outcomes. Intraventricular fibrinolysis (IVF) with low-dose recombinant tissue plasminogen activator (rtPA) can be used to improve patient outcomes. Here, we evaluated the impact of IVF on the risk of death and the functional outcomes in IVH patients with AOH. Methods: This prospective cohort study included IVH patients with hypertensive intracranial haemorrhage complicated by AOH who required EVD. We evaluated the risk of death and the functional outcomes at 1 and 3 months, with a specific focus on the impact of combined EVD with IVF by low-dose rtPA. Results: Between November 30, 2011 and December 30, 2014, 80 patients were included. Forty-five patients were treated with EVD alone (EVD group) and 35 received IVF (EVD+IVF group). The 30- and 90-day mortality rates were lower in the EVD+IVF group than in the EVD group (42.2 vs. 11.4%, p = 0.003, and 62.2 vs. 20%, p < 0.001, respectively). The Graeb scores were significantly lower in the EVD+IVF group than in the EVD group (p ≤ 0.001) during the first 3 days and on day 7 after assignment. The 30-day good functional outcome (modified Rankin Scale [mRS] score 0–3) was also higher in the EVD+IVF group than in the EVD group (6.7 vs. 28.6%, p = 0.008). However, the 90-day good functional outcome (mRS score 0–3) did not significantly increase in the EVD+IVF group (30.8% in the EVD group vs. 51.6% in the EVD+IVF group, p = 0.112). Conclusions: In our prospective observational study, EVD+IVF was associated with a lower risk of death in IVH patients. EVD+IVF improved the chance of having a good functional outcome at 1 month; however, this result was no longer observed at 3 months.

Clinical Application of Microsurgery Using the Cerebellar Medulla Fissure Approach in Severe Ventricular Hemorrhage with Casting of the Fourth Ventricle and Its Influence on Neurological Recovery

“…If an intracerebral hemorrhage breaks into the ventricle, it may quickly lead to a rapid increase in intracranial pressure, acute dilation of the ventricle, and compression of the ventricle system by a hematoma, resulting in acute obstructive hydrocephalus [ 4 , 5 ]. These patients will develop critical disease quickly, with rapid onset, rapid progression, high mortality, and poor prognosis [ 6 ].…”

Clinical characteristics and factors relating to poor outcome in patients with aneurysmal subarachnoid hemorrhage in Vietnam: A multicenter prospective cohort study

“…The primary outcome of the study was poor neurological function (poor outcome) at 90 days of ictus, which was defined as mRS scores of 4 (moderately severe disability) to 6 (death) [35,37]. We also examined the following secondary outcomes: poor outcome at 30 days of ictus, mortality rate at 30 and 90 days of ictus, and incidence of complications.…”

“…• Hospital course and outcomes, including length of hospitalization, discharge status (e.g., hospital discharge, transfer to another hospital, "discharged to die" decision in which almost all patients were in grave condition or dying and classified with a modified Rankin Scale (mRS) score of 5 (severe disability) at the time of discharge [35], and death in hospital); functional outcomes at 30 and 90 days of ictus, such as mRS scores ranging from 0 (no disability) to 6 (death) [36]; and death at 30 and 90 days of ictus.…”

Cerebrospinal fluid flow on time‐spatial labeling inversion pulse images before and after treatment of congenital hydrocephalus in a dog

“…23 In human medicine, CSF drainage ("CSF-TT") is used to predict the efficacy of surgical treatment in both congenital and acquired hydrocephalus patients. [9][10][11][12][13][14][15][16][17] If the clinical signs improved after lumbar CSF-TT in iNPH patients, or after external ventricular drainage in congenital or acquired hydrocephalus patients, the CSF-TT was judged Positive. In those positive patients, surgical treatments reducing CSF volume would be expected to be effective.…”

“…8 In human medicine, the CSF-tap test (CSF-TT) (ie, drainage) is used to predict the efficacy of surgical treatment in both congenital and acquired hydrocephalus. [9][10][11][12][13][14][15][16][17] However, a recent systematic review on reliability of CSF-TT in idiopathic normal pressure hydrocephalus (iNPH) demonstrated that a negative response to CSF-TT does not necessarily imply ineligibility for shunting. 18 Recently, CSF dynamics Abbreviations: CCJ, craniocervical junction; CSF, cerebrospinal fluid; CSF-TT, CSF-tap test;…”