Transcortical approach surgery versus external ventricular drainage in treating intraventricular hemorrhage

Abstract

Intraventricular hemorrhage is a serious intracerebral hemorrhagic disease with high mortality and poor prognosis. This retrospective study designed to investigate the therapeutic effect of transcortical approach surgery versus extraventricular drainage (EVD) on patients with intraventricular hemorrhage.Patients with intraventricular hemorrhage in Zhongshan City People's Hospital from January 01, 2014 to June 01, 2019 were retrospectively examined. They were divided into transcortical approach surgery groups and EVD groups to analyze the clinical characteristics and prognosis.A total of 96 patients were enrolled in the study (24 in the transcortical approach surgery group and 72 in the EVD group). The efficiency of postoperative operation was 15/19 in the transcortical approach surgery group and 24/48 in the EVD group (P = .012). The Glasgow Outcome Scale was 3.63 ± 1.27 in the transcortical approach surgery group and 2.80 ± 1.87 in the EVD group (P = .049). The postoperative residual blood volume was 9.62 ± 3.64 mL in the transcortical approach surgery group and 33.60 ± 3.53 mL in the EVD group (P < .001). The incidence of hydrocephalus after the operation was 1/23 in the transcortical approach surgery group and 19/53 in the EVD group. The 30-day postoperative mortality was 16/56 in the EVD group and 1/23 in the transcortical approach surgery group. The transcortical approach surgery group was significantly better compared with the EVD group.This study showed that the transcortical approach for ventricular hemorrhage compared with EVD improved the hematoma clearance rate, shortened catheterization time, reduced the incidence of postoperative hydrocephalus, decreased patient mortality, led to a better prognosis, and reduced complications of hydrocephalus.

Figure 1

Pre- and postoperative CT scan images of severe IVH treated by transcortical approach surgery. (A) CT scan image at onset, with IVH and ventricular enlargement. (B) CT scan image 12 h after the transcortical approach surgery; the brain hematoma was mostly cleared. (C) CT scan images in the first week after the surgery. The hematoma was absorbed, with no significant edema and other injuries. CT, computed tomography, IVH = intraventricular hemorrhage.

Figure 2

Pre- and postoperative CT scan images of severe IVH treated by EVD. (A) CT scan image at onset, with IVH and ventricular enlargement. (B) CT scan image 12 h after the EVD; most hematoma was not cleared. (C) CT scan images in the first week after the surgery. Most hematoma was absorbed, and the tube was still placed in the ventricle. CT, computed tomography, EVD = extraventricular drainage, IVH = intraventricular hemorrhage.

Figure 3

(A) Head in the coronal position; (B) the water-level view; (C) bone window size. The bone window size was about 3 cm × 3 cm.