Effect of Early External Ventricular Drainage on Perihemorrhagic Edema and Functional Outcome in Patients with Intraventricular Hemorrhage

Abstract

External ventricular drainage (EVD) is the most common neurosurgical procedure that allows drainage of cerebral spinal fluid and intraventricular blood. Specific time threshold for insertion of EVD catheter in spontaneous intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH) has not been established. This study aimed to evaluate the association of early external ventricular drainage (EEVD) with functional outcome in patients with ICH and IVH. Propensity score matching was used to account for baseline imbalances. The modified Rankin Scale at 3 and 6 months, mortality rates at 3 and 6 months, postoperative complications, time course of edema evolution and peak perihemorrhagic edema (PHE) were compared in the two groups of patients. The rate of favorable outcome at 3 months in the EEVD group was higher than that in the REVD group. There were no differences in mRS at 6 months, nor in mortality rates at 3 and 6 months between the two groups. Volume of absolute peak PHE and rPHE in the EEVD group were significantly less than that in the REVD group. The incidences of postoperative infections in the EEVD group were lower than those in the REVD group. In our study, EEVD was associated with improved functional outcome at 3 months, reduced PHE and a lower rate of infection in ICH and IVH patients. However, this observation did not improve survival at 3 and 6 months or functional outcome at 6 months.