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

Iwaasa, Mitsutoshi; Ueba, Tetsuya; Nonaka, Masani; Okawa, Masakazu; Abe, Hiroshi; Higashi, Toshio; Inoue, Tatsuo

doi:10.1016/j.jocn.2012.09.042

Cited by 9 publications

(3 citation statements)

References 33 publications

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“…Although the published series on endoscopic IVH removal detail results similar to those with IVF, no randomized trial has proven the superiority of this approach over EVD + IVF or EVD alone. Although the combination of coiling and endoscopic IVH removal in aSAH patients has proven safe and effective, given the technical demand of endoscopic IVH removal, evidence demonstrating its superiority over EVD + IVF is needed before it can be widely adopted [ 117 , 118 , 119 , 120 ]. This can be performed in the hybrid room with a multidisciplinary team with coiling performed before or after endoscopic IVH removal [ 119 , 120 ].…”

Section: Endoscopic Ivh Removalmentioning

confidence: 99%

The Pathogenesis of Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

Kuo

Huang

2021

IJMS

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Hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) and reportedly contributes to poor neurological outcomes. In this review, we summarize the molecular and cellular mechanisms involved in the pathogenesis of hydrocephalus following aSAH and summarize its treatment strategies. Various mechanisms have been implicated for the development of chronic hydrocephalus following aSAH, including alterations in cerebral spinal fluid (CSF) dynamics, obstruction of the arachnoid granulations by blood products, and adhesions within the ventricular system. Regarding molecular mechanisms that cause chronic hydrocephalus following aSAH, we carried out an extensive review of animal studies and clinical trials about the transforming growth factor-β/SMAD signaling pathway, upregulation of tenascin-C, inflammation-dependent hypersecretion of CSF, systemic inflammatory response syndrome, and immune dysregulation. To identify the ideal treatment strategy, we discuss the predictive factors of shunt-dependent hydrocephalus between surgical clipping and endovascular coiling groups. The efficacy and safety of other surgical interventions including the endoscopic removal of an intraventricular hemorrhage, placement of an external ventricular drain, the use of intraventricular or cisternal fibrinolysis, and an endoscopic third ventriculostomy on shunt dependency following aSAH were also assessed. However, the optimal treatment is still controversial, and it necessitates further investigations. A better understanding of the pathogenesis of acute and chronic hydrocephalus following aSAH would facilitate the development of treatments and improve the outcome.

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Section: Endoscopic Ivh Removalmentioning

confidence: 99%

The Pathogenesis of Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

Kuo

Huang

2021

IJMS

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“…Any patient presenting with IVH and requiring an EVD because of intracerebral hypertension or obstructive hydrocephalus. In case IVH is due to aneurysm or AVM rupture, the vascular malformation is secured at first [3].…”

Section: Indicationsmentioning

confidence: 99%

How I do it: flexible endoscopic aspiration of intraventricular hemorrhage

2020

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Background As intraventricular blood is a strong negative prognostic factor, intraventricular hemorrhage requires prompt and aggressive management to reduce intracranial hypertension. Method A flexible scope can be used to navigate and to aspirate blood clots from all four ventricles. Complete restoration of CSF pathways from the lateral ventricle to the foramen of Magendie can be obtained. Conclusion Flexible neuroendoscopic aspiration of IVH offers the opportunity to immediately reduce intracranial hypertension, reduce EVD obstruction and replacement rates, and decrease infections and shunt dependency.

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“…In older children and adults, PHH is mostly due to bleeding from aneurysms or vascular malformations. In elderly patients, PHH is mostly caused by bleeding into the ventricular system from a hypertensive parenchymal haemorrhage [12][13][14][15][16][17][18][19]. Such pathological posthemorrhagic brain water accumulation is generally attributed to impaired clearance of CSF caused by obstruction of CSF flow pathways.…”

Section: Introductionmentioning

confidence: 99%

Lysophosphatidic acid, a CSF marker in posthemorrhagic hydrocephalus that drives CSF accumulation via TRPV4-induced hyperactivation of NKCC1

Toft-Bertelsen

Barbuskaite

Herfoordt

et al. 2022

Preprint

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A range of neurological pathologies can cause secondary hydrocephalus. For decades, treatment has been limited to surgical CSF diversion, as still no pharmacological options exist due to the elusive molecular nature of the CSF secretion apparatus and its regulatory properties. We have now identified phospholipid lysophosphatidic acid (LPA) as a biomarker for posthemorrhagic hydrocephalus (PHH) in patients with subarachnoid hemorrhage (SAH) and mimicked our results in an animal model of intraventricular hemorrhage (IVH). Intraventricular administration of LPA caused elevated brain water content and ventriculomegaly in experimental rats, via its action as an agonist of the choroidal transient receptor potential vanilloid 4 (TRPV4) channel. TRPV4 was revealed as a novel regulator of ICP in experimental rats via its ability to modulate the CSF secretion rate through its direct activation of the Na+, K+, 2Cl- cotransporter (NKCC1) implicated in CSF secretion. Together, our data reveal that a biomarker present in brain pathologies with hemorrhagic events promotes CSF hypersecretion and ensuing brain water accumulation via its direct action on TRPV4 and its downstream regulation of NKCC1. TRPV4 may therefore be a promising future pharmacological target for pathologies involving disturbed brain fluid dynamics.

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

Cited by 9 publications

References 33 publications

The Pathogenesis of Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

The Pathogenesis of Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

How I do it: flexible endoscopic aspiration of intraventricular hemorrhage

Lysophosphatidic acid, a CSF marker in posthemorrhagic hydrocephalus that drives CSF accumulation via TRPV4-induced hyperactivation of NKCC1

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