Technical Note: Endoscopic Evacuation of Intraventricular Hemorrhage During Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Abstract

Abstract INTRODUCTION Intraventricular hemorrhage (IVH) associated with intracerebral hemorrhage (ICH) predicts increased mortality and morbidity. The use of minimally invasive endoscopic ICH evacuation has been proposed to directly address these conditions in recent years. It is unclear if IVH evacuation should be performed during minimally invasive ICH evacuation, and if so, then with what technique. Here we present a series of minimally invasive endoscopic IVH evacuations performed concurrently with ICH evacuation. METHODS A retrospective review of a prospectively collected database was performed on patients who underwent minimally invasive endoscopic ICH evacuation from December 2015 to August 2018 in a single health system. The severity of IVH was assessed using the modified Graeb (mGraeb) score as reported by Morgan et al. Hemorrhage volume was measured using the ABC/2 method. Descriptive statistics were performed. RESULTS A total of 40 patients with ICH and concurrent IVH (41.7%) were identified in a population of 96 patients who underwent minimally invasive endoscopic evacuation for spontaneous supratentorial ICH. The average preoperative mGraeb score was 9.2, while the average postoperative mGraeb score was 6.8. Of these 40 patients, 23 (57.5%) underwent minimally invasive endoscopic IVH evacuation. An anterior approach was used in 52.2% of patients, while a posterior approach was used in 47.8% of patients. Direct ventricular access was performed in 17.4% of approaches, while a transhematomal approach was used 82.6% of the time. Successful reduction of IVH measured by mGraeb score occurred in 73.9% of cases. Seventeen percent of patients without a preoperative external ventricular drain (EVD) required an intra- or postoperative EVD and 26.1% of patients eventually needed a ventriculo-peritoneal shunt (VPS). CONCLUSION The SCUBA technique provides a high percentage of successful IVH evacuation with a subsequent low need for permanent VPS. Multiple approaches to removing IVH are possible and need further study.