Endoscopic evacuation of intraventricular hematoma and third ventriculostomy

Abstract

We discuss the surgical procedure and results concerning the endoscopic evacuation of intraventricular hematoma (IVH) and third ventriculostomy in 12 cases suffering from constricting intraventricular hematoma associated with intracerebral hemorrhage. Initially, the fiberscope was introduced into the anterior horn of the lateral ventricle, and the hematoma located therein was evacuated by aspiration using a syringe directly connected to the working channel of the fiberscope. Evacuation of the hematoma was subsequently carried out in the third ventricle, aqueduct and fourth ventricle. After the evacuation of the intraventricular hematoma, a third ventriculostomy was performed to treat acute obstructive hydrocephalus. Finally, the procedure was completed with the evacuation of the hematoma in the lateral ventricle. Septostomy and evacuation in the contra-lateral ventricle was performed as the case warranted. Sufficient evacuation of the hematoma and prevention of subsequent hydrocephalus were noted in all cases, and no major surgically related complications were encountered. We conclude that for patients with intraventricular hematoma, associated with intracerebral hemorrhage, the endoscopic evacuation of the hematoma results in sufficient removal of the same, a reduction of hospitalization time and prevention of subsequent hydrocephalus.