1
|
Wang C, Bai J, He Q, Jiao Y, Zhang W, Huo R, Wang J, Xu H, Zhao S, Wu Z, Sun Y, Yu Q, Tang J, Zeng X, Yang W, Cao Y. Therapy management and outcome of acute hydrocephalus secondary to intraventricular hemorrhage in adults. Chin Neurosurg J 2024; 10:17. [PMID: 38831472 PMCID: PMC11149196 DOI: 10.1186/s41016-024-00369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Intraventricular hemorrhage (IVH) refers to bleeding within the brain's ventricular system, and hydrocephalus is a life-threatening complication of IVH characterized by increased cerebrospinal fluid accumulation in the ventricles resulting in elevated intracranial pressure. IVH poses significant challenges for healthcare providers due to the complexity of the underlying pathophysiology and lack of standardized treatment guidelines. Herein, we performed a systematic review of the treatment strategies for hydrocephalus secondary to IVH. METHODS This systematic review was prospectively registered with PROSPERO (CRD42023450786). The search was conducted in PubMed, Cochrane Library, and Web of Science on July 15, 2023. We included original studies containing valid information on therapy management and outcome of hydrocephalus secondary to primary, spontaneous, and subarachnoid or intracranial hemorrhage following IVH in adults that were published between 2000 and 2023. Glasgow Outcome Scale (GOS) or modified Ranking Scale (mRS) scores during follow-up were extracted as primary outcomes. The risk of bias was assessed using the Newcastle-Ottawa Scale for Cohort Studies or Cochrane Risk of Bias 2.0 Tool. RESULTS Two hundred and seven patients from nine published papers, including two randomized controlled trials, were included in the analysis. The GOS was used in five studies, while the mRS was used in four. Seven interventions were applied, including craniotomy for removal of hematoma, endoscopic removal of hematoma with/without endoscopic third ventriculostomy (ETV), traditional external ventricular drainage (EVD), and various combinations of EVD, lumbar drainage (LD), and intraventricular fibrinolysis (IVF). Endoscopic removal of hematoma was performed in five of nine studies. Traditional EVD had no obvious benefit compared with new management strategies. Three different combinations of EVD, LD, and IVF demonstrated satisfactory outcomes, although more studies are required to confirm their reliability. Removal of hematoma through craniotomy generated reliable result. Generally, endoscopic removal of hematoma with ETV, removal of hematoma through craniotomy, EVD with IVF, and EVD with early continuous LD were useful. CONCLUSION EVD is still crucial for the management of IVH and hydrocephalus. Despite a more reliable result from the removal of hematoma through craniotomy, a trend toward endoscopic approach was observed due to a less invasive profile.
Collapse
Affiliation(s)
- Chaoyang Wang
- Department of Neurosurgery, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Jianuo Bai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South West 4th Ring Road, Beijing, China
| | - Qiheng He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South West 4th Ring Road, Beijing, China
| | - Yuming Jiao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South West 4th Ring Road, Beijing, China
| | - Wenqian Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South West 4th Ring Road, Beijing, China
| | - Ran Huo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South West 4th Ring Road, Beijing, China
| | - Jie Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South West 4th Ring Road, Beijing, China
| | - Hongyuan Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South West 4th Ring Road, Beijing, China
| | - Shaozhi Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South West 4th Ring Road, Beijing, China
| | - Zhiyou Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South West 4th Ring Road, Beijing, China
| | - Yingfan Sun
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South West 4th Ring Road, Beijing, China
| | - Qifeng Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South West 4th Ring Road, Beijing, China
| | - Jinyi Tang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South West 4th Ring Road, Beijing, China
| | - Xianwei Zeng
- Department of Neurosurgery, National Research Center for Rehabilitation Technical Aids, Beijing, China
- Department of Neurosurgery, Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, Beijing, China
- Key Laboratory of Neuro-Functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Beijing, China
| | - Wuyang Yang
- Department of Neurosurgery, The Johns Hopkins Hospital, 1800 Orleans Street Suite 6007, Baltimore, MD, 21287, USA.
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South West 4th Ring Road, Beijing, China.
| |
Collapse
|
2
|
Yan Z, Wan X, Li Y, Zhao K, Huang Y, He X, Zhang X, Ma X, Liu Y, Niu H, Shu K, Zhang H, Lei T. Safety and efficacy of extra-ventricular drainage combined with urokinase administration in the management of intraventricular hemorrhage. Neurochirurgie 2022; 68:e53-e59. [DOI: 10.1016/j.neuchi.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
|
5
|
Iwaasa M, Ueba T, Okawa M, Inoue T. Analysis of combined coiling and neuroendoscopy in the treatment of intraventricular hemorrhage due to ruptured aneurysm. ACTA NEUROCHIRURGICA. SUPPLEMENT 2014; 119:49-52. [PMID: 24728632 DOI: 10.1007/978-3-319-02411-0_8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) with intraventricular hemorrhage (IVH) is associated with poor outcomes. The aim of this study was to evaluate the effectiveness of combined coiling and neuroendoscopy to treat severe SAH with massive IVH. METHOD Between April 2008 and March 2012, 13 patients had massive IVH with a ruptured aneurysm treated at the Department of Neurosurgery, Fukuoka University, Japan. All 13 patients were treated within 2 days of onset by coiling and neuroendoscopic removal of the IVH, including the fourth ventricle. RESULTS No rebleeding or acute hydrocephalus were noted. Glasgow Outcome Scale scores (GOS) at discharge were: good recovery (two patients), moderate disability (three patients), severe disease (one patient), vegetative state (four patients), and dead (three patients). A good modified Rankin Scale score (mRS) (0-2) at 6 months was observed in six patients and a poor mRS score (3-6) occurred in seven. The pre- and post-operative Graeb scores were significantly lower in the good mRS group (p = 0.020 and 0.033, respectively, Mann-Whitney U-test). GOS scores at discharge were significantly associated with mRS score at 6 months (p = 0.011, Fisher's Exact Test). CONCLUSIONS Combined coiling and neuroendoscopic removal of the IVH, including the fourth ventricle, were feasible procedures and achieved preferable outcomes in approximately half of the cases.
Collapse
Affiliation(s)
- Mitsutoshi Iwaasa
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jounan-ku, Fukuoka City, Fukuoka, 814-0180, Japan
| | | | | | | |
Collapse
|
6
|
Ziai WC, Tuhrim S, Lane K, McBee N, Lees K, Dawson J, Butcher K, Vespa P, Wright DW, Keyl PM, Mendelow AD, Kase C, Wijman C, Lapointe M, John S, Thompson R, Thompson C, Mayo S, Reilly P, Janis S, Awad I, Hanley DF. A multicenter, randomized, double-blinded, placebo-controlled phase III study of Clot Lysis Evaluation of Accelerated Resolution of Intraventricular Hemorrhage (CLEAR III). Int J Stroke 2013; 9:536-42. [PMID: 24033910 DOI: 10.1111/ijs.12097] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 04/16/2013] [Indexed: 01/15/2023]
Abstract
BACKGROUND In adults, intraventricular thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) facilitates resolution of intraventricular haemorrhage (IVH), reduces intracranial pressure, decreases duration of cerebrospinal fluid diversion, and may ameliorate direct neural injury. We hypothesize that patients with small parenchymal haematoma volumes (<30 cc) and relatively large IVH causing acute obstructive hydrocephalus would have improved clinical outcomes when given injections of low-dose rtPA to accelerate lysis and evacuation of IVH compared with placebo. METHODS The Clot Lysis Evaluation of Accelerated Resolution of Intraventricular Hemorrhage III trial is an investigator-initiated, phase III, randomized, multicenter, double-blind, placebo-controlled study comparing the use of external ventricular drainage (EVD) combined with intraventricular injection of rtPA to EVD plus intraventricular injection of normal saline (placebo) for the treatment of IVH. Patients with known symptom onset within 24 h of the computed tomography scan confirmed IVH and third or fourth ventricle obstruction, with or without supratentorial intracerebral haemorrhage volume <30 cc, who require EVD are screened with a computed tomography scan at least six hours after EVD placement and, if necessary, at consecutive 12-h intervals until stabilization of any intracranial bleeding has been established. Patients who meet clinical and imaging criteria (no ongoing coagulopathy and no suspicion of aneurysm, arteriovenous malformation, or any other vascular anomaly) will be randomized to either intraventricular rtPA or placebo. RESULTS The primary outcome measure is dichotomized modified Rankin Scale 0-3 vs. 4-6 at 180 days. Clinical secondary outcomes include additional modified Rankin Scale dichotomizations at 180 days (0-4 vs. 5-6), ordinal modified Rankin Scale (0-6), mortality and safety events at 30 days, mortality at 180 days, functional status measures, type and intensity of intensive care unit management, rate and extent of ventricular blood clot removal, and quality of life measures.
Collapse
Affiliation(s)
- Wendy C Ziai
- Division of Neurosciences Critical Care, Department of Neurology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Iwaasa M, Ueba T, Nonaka M, Okawa M, Abe H, Higashi T, Inoue T. Safety and feasibility of combined coiling and neuroendoscopy for better outcomes in the treatment of severe subarachnoid hemorrhage accompanied by massive intraventricular hemorrhage. J Clin Neurosci 2013; 20:1264-8. [PMID: 23830690 DOI: 10.1016/j.jocn.2012.09.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 09/18/2012] [Accepted: 09/26/2012] [Indexed: 10/26/2022]
Abstract
Subarachnoid hemorrhage (SAH) with intraventricular hemorrhage (IVH) is associated with poor outcomes. The aim of this study was to evaluate the safety and feasibility of combined coiling and neuroendoscopy for treating severe SAH with massive IVH. Between April 2008 and June 2011, 49 patients with a severe SAH were treated at the Department of Neurosurgery, Fukuoka University, Japan; 10 of these patients had a massive IVH with a ruptured aneurysm. All 10 patients (three men and seven women; mean age, 63.1±8.5 years) were treated with coiling and neuroendoscopic removal of the IVH within 2 days of onset. Coiling was successfully performed at a mean volume embolization ratio of 21.8±5.5%. Neuroendoscopic removal of the IVH reduced the mean Graeb score from 10.5±2.0 to 4.8±2.5 (p=0.005). All external drains were removed on day 3. No rebleeding or acute hydrocephalus was noted. The Glasgow Outcome Scale scores at discharge indicated two patients with good recovery, three with moderate disability, four in a vegetative state, and one dead. A good modified Rankin Scale (mRS) score (0-2) at least 6 months later (mean follow-up period, 15.4±9.2 months) was observed for five patients (50%), and a poor mRS score (3-6) was observed for the remaining four patients. Neuroendoscopically removing the IVH from all of the ventricles between the lateral and the fourth ventricle and coiling the ruptured aneurysm is a safe, feasible approach for treating severe SAH with massive IVH.
Collapse
Affiliation(s)
- Mitsutoshi Iwaasa
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jounan-ku, Fukuoka City, Fukuoka 814-0180, Japan
| | | | | | | | | | | | | |
Collapse
|
8
|
Weber C, Jakola AS, Gulati S, Nygaard ØP, Solheim O. Evidence-based clinical management and utilization of new technology in European neurosurgery. Acta Neurochir (Wien) 2013; 155:747-54. [PMID: 23440373 DOI: 10.1007/s00701-013-1640-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 02/06/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Evidence-based medicine (EBM) has become one of the pillars of modern patient care. However, neurosurgery has always been an experience-based and technology-driven discipline, and it remains unknown to which extent European neurosurgeons follow high-level evidence-based recommendations. METHODS We conducted a Web-based survey with a 15-item questionnaire about evidence-based clinical management and utilization of new technology among European neurosurgeons. Two different sum scores were calculated from the questions concerning clinical practice; evidence-based treatment score and new technology score. A high evidence-based treatment score means that more clinical conditions (i.e., study questions) were managed in compliance with the available highest levels of evidence from published clinical trials. A high new technology score reflects the use of a high number of modern tools in neurosurgical practice. RESULTS A total of 239 neurosurgeons from 30 different European countries answered the questionnaire. There were large variations among European neurosurgeons in providing evidence-based care and in utilization of various modern tools. There were significant regional differences in evidence-based treatment scores and modern technology scores with higher scores in northern and western Europe. High-volume institutions were not associated with better evidence-based treatment scores, but had significantly higher new technology scores. There were significantly higher new technology scores at university hospitals and a trend towards higher evidence-based treatment scores compared to other hospitals. CONCLUSIONS Clinical management in neurosurgery does not always comply with the best available evidence and there are large regional differences in clinical management and in utilization of various modern tools. The position of evidence-based medicine in European neurosurgery seems weak and this may be a threat to the quality of care.
Collapse
|