Biportal Endoscopic Removal of a Primary Intraventricular Hematoma: Case Report

Primary intraventricular hematomas account for approximately 6 % of all intracerebral hematomas. If the clot blocks cerebrospinal fluid (CSF) pathways, surgical intervention, which may be of different types, can be life-saving. In the case reported here, after careful preoperative planning the use of two rigid endoscopes permitted the removal of most of the intraventricular clot and restoration of CSF circulation by creation of a 3^rd ventriculostomy within the same procedure and no later treatment was necessary. Repeated CT scans proved that only a small portion of the intraventricular clot remained in the ventricular system. The ventricular size normalised, and the patency of the artificial hole in the floor of the 3^rd ventricle was demonstrated both by the rapidly improving clinical picture of the patient and by flow-sensitive MRI studies. For individuals who suffer primary intraventricular hemorrhage and later develop occlusive hydrocephalus, endoscopic removal of the clot and 3^rd ventriculostomy might offer a more adequate treatment option than external ventricular drainage.

Key words:

Biportal endoscopy - Primary intraventricular hematoma - 3^rd ventriculostomy

References

• 1 Magyar H, Grexa E, Szirmai I. Prognostic factors in spontaneous cerebral hemorrhages (in Hungarian with English summary).  Clinical Neuroscience/Ideggyógyászati Szemle. 1992;  45 354-359
• 2 Pia H W. The surgical treatment of intracerebral and intraventricular hematomas.  Acta Neurochir. 1972;  27 149-164
• 3 Radberg J A, Olsson J E, Radberg C T. Prognostic parameters in spontaneously intracerebral hematomas with special reference to anticoagulant treatment.  Stroke. 1991;  22 571-576
• 4 Young W B, Lee K P, Pessin M S, Kwan E S, Rand W M, Caplan L R. Prognostic significance of ventricular blood in supratentorial hemorrhage: a volumetric study.  Neurology. 1990;  40 616-619
• 5 Avol M, Vogel P J. Circumscribed intraventricular hematoma simulating encapsulated neoplasm.  Bull Los Angeles Neurol Soc. 1955;  20 25-29
• 6 Ojemann R G, New P FJ. Spontaneous resolution of an intraventricular hematoma.  J Neurosurg. 1963;  20 899-902
• 7 Darby D G, Donnan G A, Saling M A, Walsh K W, Bladin P F. Primary intraventricular hemorrhage: clinical and neuropsychological findings in a prospective stroke series.  Neurology. 1988;  38 68-75
• 8 Jayakumar P N, Taly A B, Rao Bhavani U, Arya B YT, Nagaraya D. Prognosis in solitary intraventricular hemorrhage.  Acta Neurol Scand. 1989;  80 1-5
• 9 Little J R, Blomquist G A, Eythier R. Intraventricular hemorrhage in adults.  Surg Neurol. 1977;  8 143-149
• 10 Paillas J E, Alliez B. Surgical treatment of spontaneous intracerebral hemorrhage. Immediate and long-term results in 250 cases.  J Neurosurg. 1973;  39 145-151
• 11 Findlay J M, Weir B KA, Stollery D E. Lysis of intraventricular hematoma with tissue plasminogen activator.  J Neurosurg. 1991;  74 803-807
• 12 Todo T, Usui M, Takakura K. Treatment of severe intraventricular hemorrhage by intraventricular infusion of urokinase.  J Neurosurg. 1991;  74 81-86
• 13 Backlund E O, von Holst H. Controlled subtotal evacuation of intracerebral hematomas by stereotactic technique.  Surg Neurol. 1978;  9 99-101
• 14 Auer L M, Deinsberger W, Niederkorn K, Gell G, Kleinert R, Schneider G, Holzer P, Bone G. et al . Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study.  J Neurosurg. 1989;  70 5-14
• 15 Vető F, Horváth Z, Dóczi T. Biportal endoscopic management of third ventricle tumors in patients with occlusive hydrocephalus: technical note.  Neurosurg. 1997;  40 871-877
• 16 Ojemann R G, Heros R. Spontaneous brain hemorrhage.  Stroke. 1983;  14 468-474
• 17 Amrein I, Juh sz C, Szirmai I. Course and prognosis of intraventricular hemorrhages.  Clinical Neuroscience/Ideggyógyászati Szemle. 1997;  50 330-335
• 18 Bogdahn U, Lau W, Hassel W, Gunreben G, Meretens H G, Brawanski A. Continuous-pressure controlled, external ventricular drainage for treatment of acute hydrocephalus - evaluation of risk factors.  Neurosurg. 1992;  31 898-903
• 19 Rajshekar V, Harbaugh R E. Results of routine ventriculostomy with external ventricular drainage for acute hydrocephalus following subarachnoid hemorrhage.  Acta Neurochir. 1992;  115 8-14
• 20 Findlay J M, Grace M GA, Weir B KA. Treatment of intraventricular hemorrhage with plasminogen activator.  Neurosurg. 1993;  32 941-947
• 21 Auer L M, Holzer P, Ascher P W, Heppner F. Endoscopic neurosurgery.  Acta Neurochir. 1989;  90 1-14

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