Hemorrhages from the thalamus and caudate nucleus are associated not infrequently with severe symptoms apparently in disproportion to a relatively slight damage to the brain substance. This is because rupture of a resultant hematoma into the ventricle, in spite of its producing an effect of mass evacuation, causes the ventricles to be filled in with blood, leading to circulatory disturbances of the cerebrospinal fluid. In such an instance, it is recommendable to perform ventricular irrigation first so as to remove bloody CSF and blood clots from the ventricles soonest possible and then proceed with bilateral ventricular drainage which is aimed at relieving an acute increase in intracranial pressure. Where blood clots are just too much to be cleared off by means of irrigation it is advisable to open the ventricles by transcallosal approach upon craniotomy and then perform continuous drainage after the elimination of blood clots by irrigation. This ventricular irrigation permits to forestall obstruction to the drain by clots and deleterious effects of the long persistence of blood in CSF and thus proves to be more beneficial when combined with drainage than when drainage alone is performed.
Emphasis is placed on the fact that the above mentioned procedure can bring about marked clinical improvement in interacerebral hemorrhage of medial type even where there are symptoms severe enough to make physician hesitate to conduct treatment with forward posture attitude.
