Long-term resolution of acute, obstructive, triventricular hydrocephalus by endoscopic removal of a third ventricular hematoma without third ventriculostomy

Abstract

The authors describe a new extension of the use of neuroendoscopy beyond that which is ordinarily performed. The authors report on the resolution of acute, obstructive, triventricular hydrocephalus in a 42-year-old woman with hypertensive caudate hemorrhage that migrated into the ventricular system. The patient underwent emergency endoscopic removal of a third ventricular hematoma, which was obstructing the orifice of the aqueduct, and restoration of cerebrospinal fluid (CSF) flow but no third ventriculostomy. The authors believe that this is the first such case to be reported. In selected cases of third ventricular hemorrhage, endoscopic removal of the intraventricular hematoma may represent a useful and effective treatment option even in emergency conditions as well as a better alternative to prolonged CSF external ventricular drainage. A reduction in the duration of hospitalization is a beneficial consequence. The authors assert that third ventriculostomy is not always needed.

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

“…[11,12] Use of endoscopy in the field of neurosurgery has been increasing and with well developed techniques and devices; various procedures of endoscopic removal of IVH have been reported. [13][14][15][16] In the present study, we performed endoscopic evacuation of IVH in 13 patients presented with obstructive hydrocephalus, and retrospectively examined the functional outcomes and intraoperative findings.…”

“…[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

“…[10222728] It is possible to perform endoscopic third ventriculostomy during IVH removal, and this procedure has been reported to be effective[134] but is not always needed. [3] We believe that these procedures are not necessary, because the IVH in the fourth ventricle lyzes within a week owing to spontaneous fibrinolysis and the pulsatile movements of the CSF. CSF flow in the aqueduct is rapid and further elevated in the case of hydrocephalus.…”

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

“…However, it must be noted that early and complete removal of IVH using endoscopy requires stamina and extremely delicate technique, and there always is a risk of incomplete IVH removal, particularly in cases where the clots are too diffi cult to aspirate. Whenever IVH is treated endoscopically, ETV is almost routinely performed although it is unclear whether it can prevent communicating hydrocephalus [18,21] . Our results suggest that ETV might support the resolution of the obstructive hydrocephalus, but do not show a preventive effect against communicating hydrocephalus when hematoma removal was insuffi cient.…”