Primary intraventricular haemorrhage: the role of frontal minicraniotomy and external ventricular drainage

Abstract

Primary intraventricular haemorrhage (PIVH) is an uncommon type of intracerebral haemorrhage, accounting for only 0.31% of all strokes and 3.1% of all intracerebral haemorrhages. Due to the low incidence of PIVH, little is known about its clinical characteristics, risk factors, aetiologies, prognosis and treatment. Acute hydrocephalus is common and is associated with a poor prognosis. External ventricular drainage (EVD) could promptly reduce intracranial pressure by diverting cerebrospinal fluid and intraventricular blood; however, the incidence of complications such as central nervous system infection, catheter occlusion and rebleeding are relatively common. Despite being an invasive procedure, frontal minicraniotomy is an available therapeutic option to avoid complications of EVD. The authors report a case of a PIVH managed with frontal minicraniotomy and perform a literature review about epidemiological data, clinical features and treatment of PIVH.

Keywords: coma and raised intracranial pressure; hydrocephalus.

Figure 1

Pr-operative axial view CT scan showing intraventricular haemorrhage in the lateral ventricles (A), Monroe foramens (B) third ventricle (C) and fourth ventricle (D) with acute hydrocephalus.

Figure 2

(A) Preoperative position and planned incisions. (B) Mini-fontal craniotomy and durotomy. (C) Transcortical approach of the right lateral ventricle with Cushing needle. (D) Intraventricular clot evacuation.

Figure 3

Seven day postoperative CT scan showing complete resolution of the intraventricular haemorrhage without signs of hydrocephalus. (A) Lateral ventricles with pneumocephalus related to surgical approach. (B) Monroe Foramen free of blood allowing cerebrospinal fluid circulation to the third (C) and fourth (D) ventricles.

Figure 4

Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram for systematic review.