Massive intraventricular hemorrhage (IVH) is nearly always associated with hydrocephalus
and is often treated with prolonged external ventricular drainage (EVD); however this
procedure can lead to bacterial ventriculitis and meningitis, which can worsen the
clinical outcomes. Endoscopic burr hole surgery to remove the hematomas in lateral
and third ventricles is an alternative treatment option. We describe the surgical
techniques and benefits of endoscopic surgery for acute massive IVH in four patients
and discuss the current published literature-related to this condition. Four patients
were treated endoscopically for massive IVH. Three patients presented with secondary
IVH due to vascular malformation, tumoral bleed and chronic hypertension, while one
case presented as massive primary IVH. Endoscopic wash out and removal of hematomas
was normally performed together with an endoscopic third ventriculostomy. Recombinant
factor VIIa was only administered prior to surgery for IVH secondary to vascular malformation
and for cases with postoperative rebleeding which required second endoscopic surgery.
Weaning from ventilator and EVD commenced on day 4 postoperatively. All treated patients
recovered and did not require further shunt surgery. Good outcomes obtained may be
related to early removal of hematomas, creation of new cerebrospinal fluid diversion
pathway after thorough wash-out, early weaning from ventilator and EVD. Endoscopic
surgery is beneficial in treating poor grade IVH with Graeb score of more than 6.
Key-words:
Endoscopy - factor VIIa - Graeb score - hydrocephalus - intraventricular haemorrhage
