Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Feb 25;10(1):5-15.
doi: 10.1136/svn-2023-003062.

Cisternal and intraventricular irrigation in subarachnoid and intraventricular haemorrhage

Allice Nyborg Rosenkrans Lind  1   2 , Mathias Green Krabbenhøft  1 , Jan Brink Valentin  3 , Mette Haldrup  1   2 , Stig Dyrskog  4 , Mads Rasmussen  5 , Claus Ziegler Simonsen  2   6 , Anders Rosendal Korshoej  7   2
Affiliations
Meta-Analysis

Cisternal and intraventricular irrigation in subarachnoid and intraventricular haemorrhage

Allice Nyborg Rosenkrans Lind et al. Stroke Vasc Neurol. .

Abstract

Background: Subarachnoid haemorrhage (SAH) and intraventricular haemorrhage (IVH) are associated with poor patient outcomes. Intraventricular fibrinolysis is effective in clearing IVH and improving patient survival and neurological outcome. By similar rationale, cisternal irrigation has been proposed as a potential method to accelerate haematoma clearance in SAH. We aimed to provide a comprehensive review and meta-analysis evaluating the effect of intraventricular and cisternal irrigation on clinical outcomes in patients with SAH and IVH.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed preparing this systematic review and study selection was performed by multiple investigators. We extracted ORs from the individual studies and aggregated these using a random effects model. The quality of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluations assessment and ROBINS-I or RoB-2.

Results: 24 articles were included. In SAH, we found that cisternal irrigation with fibrinolytic agents was associated with reduced mortality (OR: 0.68, 95% CI 0.46 to 1.00), higher probability of favourable functional outcome (OR: 1.80, 95% CI 1.30 to 2.51), and reduced risks of DCI (OR: 0.28, 95% CI 0.18 to 0.42) and cerebral vasospasm (OR: 0.28, 95% CI 0.18 to 0.42), compared with conventional therapy. Cisternal irrigation with vasodilatory agents was associated with lower mortality (OR: 0.32, 95% CI 0.13 to 0.79) and reduced risk of cerebral vasospasm (OR: 0.37, 95% CI 0.17 to 0.79). The evidence for irrigation therapy of IVH was sparse and insufficient to show any significant effect.

Conclusion: In this study, we found that cisternal irrigation could improve the prognosis in patients with SAH compared with conventional therapy. There is no evidence to support cisternal irrigation treatment of IVH.

Keywords: Hemorrhage; Intracranial Aneurysm; Subarachnoid.

PubMed Disclaimer

Conflict of interest statement

Competing interests: ARK reports grants from IRRAS AB to Aarhus University Hospital to support the ACTIVE study and personal fees from IRRAS AB for a presentation at a scientific symposium describing his experiences with the IRRAflow technology during the conduct of the study; grants from IRRAS AB to Aarhus University Hos-pital to support the development of a neuromonitoring technology related to IRRAflow outside the submitted work; in addition, ARK has a patent for a neuromonitoring technology pending with relation to the IRRAflow technology. The remaining authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart showing the study selection process.
Figure 2
Figure 2. Pooled ORs comparing combined cisternal irrigation to conventional therapy. (A) Mortality, (B) functional outcome, (C) delayed cerebral ischaemia and (D) cerebral vasospasm. RCT, randomised controlled trial.
Figure 3
Figure 3. Pooled ORs comparing fibrinolytic cisternal irrigation to conventional therapy. (A) Mortality, (B) functional outcome, (C) delayed cerebral ischaemia and (D) cerebral vasospasm. FCI, fibrinolytic cisternal irrigation; RCT, randomised controlled trial.
Figure 4
Figure 4. Pooled ORs comparing vasodilatory cisternal irrigation to treatment without vasodilatory cisternal irrigation. (A) Mortality, (B) functional outcome, (C) cerebral vasospasm. RCT, randomised controlled trial; VCI, vasodilatory cisternal irrigation.
See this image and copyright information in PMC

References

    1. Coppadoro A, Citerio G. Subarachnoid hemorrhage: an update for the Intensivist. Minerva Anestesiol. 2011;77:74–84. - PubMed
    1. Qureshi AI, Tuhrim S, Broderick JP, et al. Spontaneous intracerebral hemorrhage. N Engl J Med. 2001;344:1450–60. doi: 10.1056/NEJM200105103441907. - DOI - PubMed
    1. 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. Lancet. 2017;389:603–11. doi: 10.1016/S0140-6736(16)32410-2. - DOI - PMC - PubMed
    1. Budohoski KP, Guilfoyle M, Helmy A, et al. The pathophysiology and treatment of delayed cerebral ischaemia following subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry . 2014;85:1343–53. doi: 10.1136/jnnp-2014-307711. - DOI - PubMed
    1. Connolly ES, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American heart Association/American stroke Association. Stroke. 2012;43:1711–37. doi: 10.1161/STR.0b013e3182587839. - DOI - PubMed

MeSH terms

Substances

LinkOut - more resources