Endoscope-assisted microsurgical evacuation versus external ventricular drainage for the treatment of cast intraventricular hemorrhage: results of a comparative series

This study aimed to describe the technique details of rapid pore cranial drilling with external ventricular drainage and document its clinical outcomes by highlighting the advantages over the traditional and modified cranial drilling technique. Intraventricular hemorrhage is one of the most severe subtypes of hemorrhagic stroke with high mortality. The amount of blood in the ventricles is associated with severity of outcomes, and fast removal of the blood clot is the key to a good prognosis. Between 1977 and 2013, 3773 patients admitted for intraventricular hemorrhage underwent rapid pore cranial drilling drainage. The therapeutic effects and clinical outcomes were retrospectively analyzed. Of these patients, 1049 (27.8%) experienced complete remission, 1788 (47.4%) had improved condition, and 936 (24.8%) died. A total of 3229 (85.6%) patients gained immediate remission. One typical case was illustrated to demonstrate the efficacy of the rapid pore drilling technique. Rapid pore cranial drilling drainage in patients with intraventricular hemorrhage is fast, effective, and provides immediate relief in patients with severe conditions. It could be a better alternative to the conventional drilling approach for treatment of intraventricular hemorrhage. A randomized controlled trial for direct comparison between the rapid pore cranial drilling drainage and conventional drilling technique is in urgent need.

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Smartphone‑assisted endoscopic surgery via Kocher's point for intraventricular hemorrhage caused by thalamic hemorrhage: A comparison with external ventricular drainage

Experimental and Therapeutic Medicine ◽

10.3892/etm.2019.7740 ◽

2019 ◽

Author(s):

Xin Ge ◽

Xinhua Xu ◽

Xinguang Yu ◽

Xiaolei Chen ◽

Duo Li ◽

...

Keyword(s):

Endoscopic Surgery ◽

Intraventricular Hemorrhage ◽

External Ventricular Drainage ◽

Ventricular Drainage ◽

Thalamic Hemorrhage

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Endoscopic intraventricular hematoma evacuation surgery versus external ventricular drainage for the treatment of patients with moderate to severe intraventricular hemorrhage: a multicenter, randomized, controlled trial

Trials ◽

10.1186/s13063-020-04560-3 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Junhao Zhu ◽

Chao Tang ◽

Zixiang Cong ◽

Jin Yang ◽

Xiangming Cai ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Intraventricular Hemorrhage ◽

Controlled Trial ◽

External Ventricular Drainage ◽

Ventricular Drainage ◽

Hematoma Evacuation ◽

Randomized Controlled ◽

Multicenter Randomized Controlled Trial

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Recirculatory Fibrinolytic-Assisted External Ventricular Drainage (EVD) for Intraventricular Hemorrhage

10.21203/rs.3.rs-716578/v1 ◽

2021 ◽

Author(s):

Zhen QIN ◽

John Ching Kwong Kwok ◽

Peter Yat Ming Woo ◽

Carmen Yim ◽

Chi Hang Chon

Keyword(s):

Intraventricular Hemorrhage ◽

Treatment Time ◽

Ex Vivo ◽

Obstructive Hydrocephalus ◽

External Ventricular Drainage ◽

Ventricular Drainage ◽

Fibrinolytic Agent ◽

Recirculatory Flow ◽

Previous Clinical Trial ◽

Clinical Trial Results

Abstract Background Elevated intracranial pressure and acute obstructive hydrocephalus secondary to intraventricular hemorrhage (IVH) can be treated by external ventricular drainage (EVD). The treatment time and the risk of EVD-related complications can be reduced with fibrinolytic agents’ instillation via an EVD catheter, but previous clinical trial results did not reveal a significant improvement in terms of long-term functional outcomes. A recirculatory fibrinolytic-assisted EVD system was designed. The clot dissolution effectiveness of the system under different drug dosages and fluid flow rates was tested in an ex vivo model. Results The results showed that the mean clot mass was quickly reduced in an initial fibrinolytic agent dose-independent stage, followed by a dose-dependent stage. Elevating fibrinolytic agent dosages beyond a certain threshold did not contribute to shorter dissolution times. Optimal treatment parameters for such a system were determined. A recirculatory flow rate of 10–18 ml/min with a low-dose of 30 000–60 000 IU of uPA resulted in an 80% clot mass reduction within four hours. Conclusions This recirculating fibrinolytic system is a promising novel modification of conventional IVH treatment that could reduce clot dissolution times and procedure-related complications.

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Infecção liquórica em drenagem ventricular externa: avaliação dos fatores de risco em 110 pacientes de uma única instituição

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0040-1713917 ◽

2020 ◽

Vol 39 (03) ◽

pp. 161-169

Author(s):

Itamar Cristian Larsen ◽

Jorge Eduardo F. Matias ◽

Marlus S. Moro ◽

Luana A. Maranha ◽

João Cândido Araújo

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intraventricular Hemorrhage ◽

Statistical Significance ◽

External Ventricular Drainage ◽

Ventricular Drainage ◽

Single Institution ◽

Wound Area ◽

Statistical Comparison ◽

Neurosurgical Patients

Abstract Objectives External ventricular drainage (EVD) is extensively used in the neurosurgical practice with the purpose of monitoring the intracranial pressure and draining the cerebrospinal fluid (CSF). Despite its remarkable benefits, the technique is not devoid of risks, notably infections, which have been reported in up to 45% of the cases. Methods A retrospective analysis of the main risk factors for CSF infection in neurosurgical patients submitted to EVD at a single institution. We recorded and submitted to statistical comparison every risk factor for CSF infection present or absent in each of the 110 EVD patients enrolled, 53 males and 57 females, with an average age of 52.9 years, with different underlying neurosurgical conditions. Results Infection of the CSF occurred in 32 patients (29%). The rate of mortality related to CSF infection was of 18.7% (6 of 32). The risk factors that showed statistical significance for CSF infection in this series were: emergency surgery; length of stay at the intensive care unit (UCI); duration of the EVD; parenchymal and/or intraventricular hemorrhage; simultaneous infections; time of bladder catheterization; and the use of non-disposable adhesive drapes as part of the preparation of the wound area. Conclusions Infection of the CSF in patients submitted to EVD is multifactorial and a challenge in terms of prevention. Further studies proposing scores with blended risk factors may be useful to prevent and reduce the morbidity and mortality associated with CSF infection.

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