Efficacy analysis of neuroendoscopic hematoma evacuation and external ventricular drainage in the treatment of intraventricular hemorrhage

doi:10.3877/cma.j.issn.2095-123X.2024.02.004

Abstract

Abstract:

Objective

To compare the clinical efficacy of neuroendoscopic hematoma evacuation and external ventricular drainage in the treatment of intraventricular hemorrhage (IVH).

Methods

A total of 42 patients with IVH admitted to Neurosurgery Department of the People's Hospital of Gaomi from January 2019 to February 2022 were selected and divided into an endoscopy group and a puncture group according to the random number table method, with 21 cases in each group. The endoscopic group was treated with endoscopic evacuation of ventricular hematoma, while the puncture group was treated with lateral external drainage. The Graeb score at the 8 h postoperative time point, the number of urokinase injection, the time of extubation, and the incidence of postoperative complications (intracranial infection, rebleeding, hydrocephalus), and the neurological function recovery of patients 3 months after surgery (GOS score) were compared between the two groups.

Results

The clearance of hematoma in the endoscopic group was better than that in the puncture group at 8 h after surgery, and the Graeb score was lower than that in the puncture group, with a statistically significant difference (P<0.05). The number of urokinase injections and extubation time in the endoscopic group were less than those in the puncture group, and the differences were statistically significant (P<0.05). The incidence of postoperative complications in the endoscopic group (14.29%) was lower than that in the puncture group (38.10%), but the difference was not statistically significant (P>0.05). The good prognosis rate of the endoscopic group at 3 months after surgery was higher than that of the puncture group, and the difference was statistically significant (P<0.05).

Conclusion

Neuroendoscopic treatment of IVH is safe and feasible, and it is a potentially effective surgical method, which needs to be verified by more clinical trial data.

Key words: Intraventricular hemorrhage, Neuroendoscopy, External ventricular drainage, Clinical efficacy

Jun Zhou, Zhiming Zhao, Yunfeng Liu, Zhaowei Tang, Changhua Song, Jie Liu, Haoran Li, Shaoguang Wu. Efficacy analysis of neuroendoscopic hematoma evacuation and external ventricular drainage in the treatment of intraventricular hemorrhage[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2024, 14(02): 86-92.

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References 30

[1]	Hanley DF. Intraventricular hemorrhage: severity factor and treatment target in spontaneous intracerebral hemorrhage[J]. Stroke, 2009, 40(4): 1533-1538. DOI: 10.1161/STROKEAHA.108.535419.
[2]	Hanley DF, Naff NJ, Harris DM. Intraventricular hemorrhage: presentation and management options[J]. Semin Cerebrovasc Dis Stroke, 2005, 5(3): 209-216. DOI: 10.1053/j.scds.2006.01.011.
[3]	Stein M, Luecke M, Preuss M, et al. Spontaneous intracerebral hemorrhage with ventricular extension and the grading of obstructive hydrocephalus: the prediction of outcome of a special life-threatening entity[J]. Neurosurgery, 2010, 67(5): 1243-1251; discussion 1252. DOI: 10.1227/NEU.0b013e3181ef25de.
[4]	Tuhrim S, Horowitz DR, Sacher M, et al. Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage[J]. Crit Care Med, 1999, 27(3): 617-621. DOI: 10.1097/00003246-199903000-00045.
[5]	Adams RE, Diringer MN. Response to external ventricular drainage in spontaneous intracerebral hemorrhage with hydrocephalus[J]. Neurology, 1998, 50(2): 519-523. DOI: 10.1212/wnl.50.2.519.
[6]	周军,赵月明,宋常华,等.神经内镜手术治疗自发性幕上中等程度脑出血的临床效果[J].中华神经创伤外科电子杂志, 2021, 7(1): 51-55. DOI: 10.3877/cma.j.issn.2095-9141.2021.01.012.
[7]	Jennett B, Snoek J, Bond MR, et al. Disability after severe head injury: observations on the use of the Glasgow outcome scale[J]. J Neurol Neurosurg Psychiatry, 1981, 44(4): 285-293. DOI: 10.1136/jnnp.44.4.285.
[8]	Bhattathiri PS, Gregson B, Prasad KS, et al. Intraventricular hemorrhage and hydrocephalus after spontaneous intracerebral hemorrhage: results from the STICH trial[J]. Acta Neurochir Suppl, 2006, 96: 65-68. DOI: 10.1007/3-211-30714-1_16.
[9]	Gluski J, Garling RJ, Kappel A, et al. Factors impacting hydrocephalus incidence in intracerebral hemorrhage: a retrospective analysis[J]. World Neurosurg, 2021, 148: e381-e389. DOI: 10.1016/j.wneu.2020.12.164.
[10]	Trifan G, Arshi B, Testai FD. Intraventricular hemorrhage severity as a predictor of outcome in intracerebral hemorrhage[J]. Front Neurol, 2019, 10: 10217. DOI: 10.3389/fneur.2019.00217.
[11]	Ziai WC, Tuhrim S, Lane K, et al. A multicenter, randomized, double-blinded, placebo-controlled phase III study of clot lysis evaluation of accelerated resolution of intraventricular hemorrhage (CLEAR III)[J]. Int J Stroke, 2014, 9(4): 536-542. DOI: 10.1111/ijs.12097.
[12]	Steiner T, Diringer MN, Schneider D, et al. Dynamics of intraventricular hemorrhage in patients with spontaneous intracerebral hemorrhage: risk factors, clinical impact, and effect of hemostatic therapy with recombinant activated factor VII[J]. Neurosurgery, 2006, 59(4): 767-773; discussion 773-764. DOI: 10.1227/01.Neu.0000232837.34992.32.
[13]	Wahjoepramono POP, Sasongko AB, Halim D, et al. Hydrocephalus is an independent factor affecting morbidity and mortality of ICH patients: systematic review and meta-analysis[J]. World Neurosurg X, 2023, 19: 100194. DOI: 10.1016/j.wnsx.2023.100194.
[14]	Staykov D, Bardutzky J, Huttner HB, et al. Intraventricular fibrinolysis for intracerebral hemorrhage with severe ventricular involvement[J]. Neurocrit Care, 2011, 15(1): 194-209. DOI: 10.1007/s12028-010-9390-x.
[15]	Naff NJ, Carhuapoma JR, Williams MA, et al. Treatment of intraventricular hemorrhage with urokinase: effects on 30-day survival[J]. Stroke, 2000, 31(4): 841-847. DOI: 10.1161/01.str.31.4.841.
[16]	Hinson HE, Hanley DF, Ziai WC. Management of intraventricular hemorrhage[J]. Curr Neurol Neurosci Rep, 2010, 10(2): 73-82. DOI: 10.1007/s11910-010-0086-6.
[17]	Hanley DF, Lane K, McBee N, et al. Thrombolytic removal of intraventricular haemorrhage in treatment of severe stroke: results of the randomised, multicentre, multiregion, placebo-controlled CLEAR III trial[J]. Lancet, 2017, 389(10069): 603-611. DOI: 10.1016/s0140-6736(16)32410-2.
[18]	Hemphill JC, 3rd, Greenberg SM, Anderson CS, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2015, 46(7): 2032-2060. DOI: 10.1161/str.0000000000000069.
[19]	Auer LM. Endoscopic evacuation of intracerebral haemorrhage. High-tec-surgical treatment--a new approach to the problem?[J]. Acta Neurochir (Wien), 1985, 74(3-4): 124-128. DOI: 10.1007/bf01418801.
[20]	Chen CC, Liu CL, Tung YN, et al. Endoscopic surgery for intraventricular hemorrhage (IVH) caused by thalamic hemorrhage: comparisons of endoscopic surgery and external ventricular drainage (EVD) surgery[J]. World Neurosurg, 2011, 75(2): 264-268. DOI: 10.1016/j.wneu.2010.07.041.
[21]	Zhang Z, Li X, Liu Y, et al. Application of neuroendoscopy in the treatment of intraventricular hemorrhage[J]. Cerebrovasc Dis, 2007, 24(1): 91-96. DOI: 10.1159/000103122.
[22]	Li Y, Zhang H, Wang X, et al. Neuroendoscopic surgery versus external ventricular drainage alone or with intraventricular fibrinolysis for intraventricular hemorrhage secondary to spontaneous supratentorial hemorrhage: a systematic review and meta-analysis[J]. PLoS One, 2013, 8(11): e80599. DOI: 10.1371/journal.pone.0080599.
[23]	Proulx ST. Cerebrospinal fluid outflow: a review of the historical and contemporary evidence for arachnoid villi, perineural routes, and dural lymphatics[J]. Cell Mol Life Sci, 2021, 78(6): 2429-2457. DOI: 10.1007/s00018-020-03706-5.
[24]	Hamada H, Hayashi N, Kurimoto M, et al. Neuroendoscopic removal of intraventricular hemorrhage combined with hydrocephalus[J]. Minim Invasive Neurosurg, 2008, 51(6): 345-349. DOI: 10.1055/s-0028-1085449.
[25]	Longatti P, Fiorindi A, Martinuzzi A. Neuroendoscopic aspiration of hematocephalus totalis: technical note[J]. Neurosurgery, 2005, 57(4 Suppl): E409. DOI: 10.1227/01.neu.0000176702.26810.b7.
[26]	Longatti PL, Martinuzzi A, Fiorindi A, et al. Neuroendoscopic management of intraventricular hemorrhage[J]. Stroke, 2004, 35(2): e35-e38. DOI: 10.1161/01.Str.0000113736.73632.F6.
[27]	Yadav YR, Mukerji G, Shenoy R, et al. Endoscopic management of hypertensive intraventricular haemorrhage with obstructive hydrocephalus[J]. BMC Neurol, 2007, 7: 1. DOI: 10.1186/1471-2377-7-1.
[28]	Huttner HB, Nagel S, Tognoni E, et al. Intracerebral hemorrhage with severe ventricular involvement: lumbar drainage for communicating hydrocephalus[J]. Stroke, 2007, 38(1): 183-187. DOI: 10.1161/01.Str.0000251795.02560.62.
[29]	Liliang PC, Liang CL, Lu CH, et al. Hypertensive caudate hemorrhage prognostic predictor, outcome, and role of external ventricular drainage[J]. Stroke, 2001, 32(5): 1195-1200. DOI: 10.1161/01.str.32.5.1195.
[30]	Naff NJ, Hanley DF, Keyl PM, et al. Intraventricular thrombolysis speeds blood clot resolution: results of a pilot, prospective, randomized, double-blind, controlled trial[J]. Neurosurgery, 2004, 54(3): 577-583; discussion 583-574. DOI: 10.1227/01.neu.0000108422.10842.60.

组别	例数	年龄（岁，Mean±SD）	性别（男/女）	脑出血		出血量（mL，Mean±SD）	术前Graeb评分（分，Mean±SD）	术前GCS评分（分，Mean±SD）
组别	例数	年龄（岁，Mean±SD）	性别（男/女）	丘脑出血破入脑室	原发性脑室出血	出血量（mL，Mean±SD）	术前Graeb评分（分，Mean±SD）	术前GCS评分（分，Mean±SD）
内镜组	21	54.43±11.91	12/9	15	6	25.12±6.43	9.38±1.77	7.91±2.64
穿刺组	21	53.28±12.13	11/10	16	5	23.83±4.45	10.03±1.53	8.21±2.37
χ²/t值		0.232	0.476	0.123		1.078	0.708	1.013
P值		0.817	0.490	0.726		0.103	0.340	0.153

组别	例数	年龄（岁，Mean±SD）	性别（男/女）	脑出血		出血量（mL，Mean±SD）	术前Graeb评分（分，Mean±SD）	术前GCS评分（分，Mean±SD）
组别	例数	年龄（岁，Mean±SD）	性别（男/女）	丘脑出血破入脑室	原发性脑室出血	出血量（mL，Mean±SD）	术前Graeb评分（分，Mean±SD）	术前GCS评分（分，Mean±SD）
内镜组	21	54.43±11.91	12/9	15	6	25.12±6.43	9.38±1.77	7.91±2.64
穿刺组	21	53.28±12.13	11/10	16	5	23.83±4.45	10.03±1.53	8.21±2.37
χ²/t值		0.232	0.476	0.123		1.078	0.708	1.013
P值		0.817	0.490	0.726		0.103	0.340	0.153

组别	例数	血肿清除率（%）	尿激酶注射次数（次）	置管时间（d）	术后Graeb评分（分）
内镜组	21	76（69.5，83.0）	2（1，2）	5（4，5）	4（3，5）
穿刺组	21	42（37.5，45.5）	5（5，6）	9（8，10）	9（8，10）
Z值		-5.550	-5.633	-5.639	-5.544
P值		<0.001	<0.001	<0.001	<0.001

组别	例数	血肿清除率（%）	尿激酶注射次数（次）	置管时间（d）	术后Graeb评分（分）
内镜组	21	76（69.5，83.0）	2（1，2）	5（4，5）	4（3，5）
穿刺组	21	42（37.5，45.5）	5（5，6）	9（8，10）	9（8，10）
Z值		-5.550	-5.633	-5.639	-5.544
P值		<0.001	<0.001	<0.001	<0.001

组别	例数	颅内感染	再出血	脑积水	合计
内镜组	21	1（4.8）	0（0.0）	2（9.5）	3（14.3）
穿刺组	21	2（9.5）	2（9.5）	4（19.0）	8（38.1）
χ²值					3.079
P值					0.079

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