Comparison between endoscopic removal of the intraventricular hematoma and external ventricular drainage

Abstract

Background and purpose: External ventricular drainage (EVD) is ordinarily performed for intraventricular hemorrhage (IVH) caused by intracerebral hemorrhage. The purpose of this study was to assess the efficacy and safety of endoscopic evacuation of IVH compared with EVD. Methods: Between 2010 and 2014, nine patients treated with EVD and nine with endoscopic evacuation of IVH were studied. The following clinical data were evaluated: age, Glasgow Coma Scale (GCS) score, IVH volume, duration of EVD placement, time in rehabilitation for ambulation, duration of hospital stay, shunt dependency, complications, and modified Rankin Scale (mRS) at discharge. Results: The clinical data of the nine patients in each group showed no significant differences in age or Graeb score. Significant differences in preoperative GCS (9.7 ± 2.8 vs. 6.6 ± 1.5, p=0.017) and bicaudate cerebroventricular index (20.9 ± 9.2 vs. 24.2 ± 2.1, p=0.031) were observed. The duration of EVD placement (9.9 ± 2.8 days vs. 3.6 ± 4.3 days, p=0.019) and time in rehabilitation (10.8 ± 3.4 days vs. 6.4 ± 2.3 days, p=0.021) were significantly shorter in the endoscopic evacuation group than the EVD group. However, there was no significant difference in shunt dependency rate, complications, hospital stay, and mRS at discharge. Although endoscopic surgery was used for severe IVH, the neurological outcome at discharge was the same in both groups. Conclusions: Endoscopic intraventricular hematoma evacuation reduces the duration of EVD placement and leads to early ambulation, enabling early transfer to a rehabilitation hospital with a more favorable outcome.