Response to external ventricular drainage in spontaneous intracerebral hemorrhage with hydrocephalus

Adams, R.E.; Diringer, Michael N.

doi:10.1212/wnl.50.2.519

Cited by 143 publications

(100 citation statements)

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“…Although increased ICP is generally accepted to be a predictor of poor outcome following ICH, control ling ICP via medical and surgical means may not neces sarily improve outcomes or reduce the risk for chronic hydrocephalus. 1,21 More specifically, our final model sup ports an association between elevated ICP, despite con tinued CSF diversion with an EVD, and an increased risk of progressing to shuntdependent hydrocephalus. One explanation may be that following the onset of acute hy drocephalus, a subset of patients are prone to developing decreased ventricular compliance, poor CSF flow dy namics and reabsorption, or both, resulting in a continued need for CSF diversion.…”

Section: Discussionmentioning

confidence: 81%

Predictors of long-term shunt-dependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion

Zacharia¹,

Vaughan²,

Hickman³

et al. 2012

FOC

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Object Intracerebral hemorrhage (ICH) is frequently complicated by acute hydrocephalus, necessitating emergency CSF diversion with a subset of patients, ultimately requiring long-term treatment via placement of permanent ventricular shunts. It is unclear what factors may predict the need for ventricular shunt placement in this patient population. Methods The authors performed a retrospective analysis of a prospective database (ICH Outcomes Project) containing patients with nontraumatic ICH admitted to the neurological ICU at Columbia University Medical Center between January 2009 and September 2011. A multiple logistic regression model was developed to identify independent predictors of shunt-dependent hydrocephalus after ICH. The following variables were included: patient age, admission Glasgow Coma Scale score, temporal horn diameter on admission CT imaging, bicaudate index, admission ICH volume and location, intraventricular hemorrhage volume, Graeb score, LeRoux score, third or fourth ventricle hemorrhage, and intracranial pressure (ICP) and ventriculitis during hospital stay. Results Of 210 patients prospectively enrolled in the ICH Outcomes Project, 64 required emergency CSF diversion via placement of an external ventricular drain and were included in the final cohort. Thirteen of these patients underwent permanent ventricular CSF shunting prior to discharge. In univariate analysis, only thalamic hemorrhage and elevated ICP were significantly associated with the requirement for permanent CSF diversion, with p values of 0.008 and 0.033, respectively. Each remained significant in a multiple logistic regression model in which both variables were present. Conclusions Of patients with ICH requiring emergency CSF diversion, those with persistently elevated ICP and thalamic location of their hemorrhage are at increased odds of developing persistent hydrocephalus, necessitating permanent ventricular shunt placement. These factors may assist in predicting which patients will require permanent CSF diversion and could ultimately lead to improvements in the management of this disorder and the outcome in patients with ICH.

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Section: Discussionmentioning

confidence: 81%

Predictors of long-term shunt-dependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion

Zacharia¹,

Vaughan²,

Hickman³

et al. 2012

FOC

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“…Although ventriculostomy reduces ICP, frequent clots in the catheter and infections often diminish the beneficial effect on hydrocephalus and neurological status. 2 We prefer to use prophylactic antibiotic medications in patients with ICP monitoring devices. Sedation with benzodiazepines, narcotic analgesics, or propofol can help control elevated ICP.…”

Section: Neurosurg Focus / Volume 15 / October 2003mentioning

confidence: 99%

Spontaneous intracerebral hemorrhage: a review

Fewel¹,

Thompson²,

Hoff³

2003

FOC

143

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Spontaneous intracerebral hemorrhage (SICH) is a blood clot that arises in the brain parenchyma in the absence of trauma or surgery. This entity accounts for 10 to 15% of all strokes and is associated with a higher mortality rate than either ischemic stroke or subarachnoid hemorrhage. Common causes include hypertension, amyloid angiopathy, coagulopathy, vascular anomalies, tumors, and various drugs. Hypertension, however, remains the single greatest modifiable risk factor for SICH. Computerized tomography scanning is the initial diagnostic modality of choice in SICH, and angiography should be considered in all cases except those involving older patients with preexisting hypertension in thalamic, putaminal, or cerebellar hemorrhage. Medical management includes venous thrombosis prophylaxis, gastric cytoprotection, and aggressive rehabilitation. Anticonvulsant agents should be prescribed in supratentorial SICH, whereas the management of hypertension is controversial. To date, nine prospective randomized controlled studies have been conducted to compare surgical and medical management of SICH. Although definitive evidence favoring surgical intervention is lacking, there is good theoretical rationale for early surgical intervention. Surgery should be considered in patients with moderate to large lobar or basal ganglia hemorrhages and those suffering progressive neurological deterioration. Elderly patients in whom the Glasgow Coma Scale score is less than 5, those with brainstem hemorrhages, and those with small hemorrhages do not typically benefit from surgery. Patients with cerebellar hemorrhages larger than 3 cm, those with brainstem compression and hydrocephalus, or those exhibiting neurological deterioration should undergo surgical evacuation of the clot. It is hoped that the forthcoming results of the International Surgical Trial in IntraCerebral Hemorrhage will help formulate evidence-based recommendations regarding the role of surgery in SICH.

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“…5) Extraventricular drainage (EVD) is generally used to treat IVH, but is sometimes complicated by infection or catheter blockage, unresolved hematoma and protracted hydrocephalus, and problems may persist, ultimately requiring ventriculoperitoneal shunting. 1) Recent progress in neuroendoscopy allows minimally invasive surgery for patients with cerebral hemorrhage, and use of this technique for IVH can safely achieve reliable decompression and improvement of non-communicating hydrocephalus in the acute phase. 4,8,9,14) The present study describes our surgical technique of endoscopic evacuation for IVH, using both rigid and flexible endoscopes for aggressive treatment of hyperacute IVHs, compares the outcomes achieved by endoscopic removal and by EVD at our hospital, and discusses the usefulness of endoscopic removal.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Clinical Outcomes of Intraventricular Hematoma Between Neuroendoscopic Removal and Extraventricular Drainage

Komatsu

Wakuta

et al. 2010

Neurol. Med. Chir.(Tokyo)

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The efficacy of treatment for intraventricular hematoma by neuroendoscopic surgery and extraventricular drainage was compared in 10 patients with intraventricular hematoma and hydrocephalus who underwent neuroendoscopic surgery (endoscopic group), and eight patients with intraventricular hematoma and hydrocephalus treated with extraventricular drainage (EVD group). The outcomes in each group were assessed retrospectively using the Graeb scores on the pre-and postoperative computed tomography (CT), duration of extraventricular drainage, requirement for a shunt operation, and modified Rankin scale score at 12 months. The Graeb scores on the preoperative CT were not significantly different between the two groups, but the duration of catheter placement was significantly shorter (69.3%) in the endoscopic group (2.7 days) than in the EVD group (8.8 days). None of the patients in either group required a shunt procedure for communicating hydrocephalus 12 months after surgery. Neuroendoscopic removal is a safe and effective procedure for intraventricular hematoma. Advantages include rapid removal of hematoma in the ventricular systems and reliable improvement of non-communicating hydrocephalus in the acute phase. The procedure resulted in faster removal of the catheter in the postoperative period and earlier patient ambulation.

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Response to external ventricular drainage in spontaneous intracerebral hemorrhage with hydrocephalus

Cited by 143 publications

References 0 publications

Predictors of long-term shunt-dependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion

Predictors of long-term shunt-dependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion

Spontaneous intracerebral hemorrhage: a review

Comparison of Clinical Outcomes of Intraventricular Hematoma Between Neuroendoscopic Removal and Extraventricular Drainage

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