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Intensivmedizin up2date 2014; 10(03): 249-259
DOI: 10.1055/s-0034-1377618
Neuro-Intensivmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Intraventrikuläre Blutungen

Stefan Wolf
,
Dimitre Staykov
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Publication History

Publication Date:
19 August 2014 (online)

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Kernaussagen

  • Die ernste Prognose eines Patienten mit ventrikulärer Blutung hat sich in den letzten Jahren durch neue Therapieverfahren deutlich verbessert.

  • Derzeit sind diese Therapieverfahren noch experimentell und sollten bevorzugt im Rahmen laufender klinischer Studien und in Zentren mit ausgewiesener Expertise durchgeführt werden.

  • Die intraventrikuläre Fibrinolyse über eine externe Ventrikeldrainage kann bei schweren Ventrikelblutungen möglicherweise die Mortalität senken und das funktionelle Outcome verbessern.

  • Alternativ oder in Kombination hierzu ist eine lumbale Drainage möglich.

  • Insbesondere in Kombination mit einer intraventrikulären Lyse kann die lumbale Drainage möglicherweise permanente shuntpflichtige Liquorzirkulationsstörungen reduzieren.

  • Nach einer Subarachnoidalblutung kann die lumbale Drainage die Inzidenz von Vasospasmen senken.

 

  • Literatur

  • 1 Andrews CO, Engelhard HH. Fibrinolytic therapy in intraventricular hemorrhage. Ann Pharmacother 2001; 35: 1435-1448
    CrossrefPubMedGoogle Scholar
  • 2 Maas MB, Nemeth AJ, Rosenberg NF et al. Delayed intraventricular hemorrhage is common and worsens outcomes in intracerebral hemorrhage. Neurology 2013; 80: 1295-1299
    CrossrefPubMedGoogle Scholar
  • 3 Kim BJ, Lee SH, Ryu WS et al. Extents of white matter lesions and increased intraventricular extension of intracerebral hemorrhage. Crit Care Med 2013; 41: 1325-1331
    CrossrefPubMedGoogle Scholar
  • 4 Diringer MN, Edwards DF, Zazulia AR. Hydrocephalus: a previously unrecognized predictor of poor outcome from supratentorialintracerebral hemorrhage. Stroke J Cereb Circ 1998; 29: 1352-1357
    CrossrefPubMedGoogle Scholar
  • 5 Graeb DA, Robertson WD, Lapointe JS et al. Computed tomographic diagnosis of intraventricular hemorrhage. Etiology and prognosis. Radiology 1982; 143: 91-96
    CrossrefPubMedGoogle Scholar
  • 6 Staykov D, Schwab S. Clearing bloody cerebrospinal fluid: clot lysis, neuroendoscopy and lumbar drainage. Curr Opin Crit Care 2013; 19: 92-100
    CrossrefPubMedGoogle Scholar
  • 7 Claassen J, Bernardini GL, Kreiter K et al. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke J Cereb Circ 2001; 32: 2012-2020
    CrossrefPubMedGoogle Scholar
  • 8 Kiphuth IC, Huttner HB, Breuer L et al. Vasospasm in intracerebral hemorrhage with ventricular involvement: a prospective pilot transcranial Doppler sonography study. Cerebrovasc Dis Basel Switz 2011; 32: 420-425
    PubMedGoogle Scholar
  • 9 Regula JU, Schill J, Ringleb PA et al. Cerebral Vasospasm and Delayed Cerebral Ischemia in Intraventricular Hemorrhage. Neurocrit Care 2014; 20: 460-465
    CrossrefPubMedGoogle Scholar
  • 10 Lozier AP, Sciacca RR, Romagnoli MF et al. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery 2002; 51: 170-181 ; discussion 181–182
    CrossrefPubMedGoogle Scholar
  • 11 Naff N, Williams MA, Keyl PM et al. Low-dose recombinant tissue-type plasminogen activator enhances clot resolution in brain hemorrhage: the intraventricular hemorrhage thrombolysis trial. Stroke J Cereb Circ 2011; 42: 3009-3016
    CrossrefPubMedGoogle Scholar
  • 12 Wang K, Du HG, Yin LC et al. Which side of lateral ventricles to choose during external ventricular drainage in patients with intraventricular hemorrhage: ipsilateral or contralateral?. J Surg Res 2013; 183: 720-725
    CrossrefPubMedGoogle Scholar
  • 13 Staykov D, Huttner HB, Lunkenheimer J et al. Single versus bilateral external ventricular drainage for intraventricular fibrinolysis in severe ventricular haemorrhage. J Neurol Neurosurg Psychiatry 2010; 81: 105-108
    CrossrefPubMedGoogle Scholar
  • 14 Hinson HE, Melnychuk E, Muschelli J et al. Drainage efficiency with dual versus single catheters in severe intraventricular hemorrhage. Neurocrit Care 2012; 16: 399-405
    CrossrefPubMedGoogle Scholar
  • 15 Staykov D, Bardutzky J, Huttner HB et al. Intraventricular fibrinolysis for intracerebral hemorrhage with severe ventricular involvement. Neurocrit Care 2011; 15: 194-209
    CrossrefPubMedGoogle Scholar
  • 16 Ziai WC, Muschelli J, Thompson CB et al. Factors affecting clot lysis rates in patients with spontaneous intraventricular hemorrhage. Stroke J Cereb Circ 2012; 43: 1234-1239
    CrossrefPubMedGoogle Scholar
  • 17 Staykov D, Wagner I, Volbers B et al. Dose effect of intraventricular fibrinolysis in ventricular hemorrhage. Stroke J Cereb Circ 2011; 42: 2061-2064
    CrossrefPubMedGoogle Scholar
  • 18 Webb AJS, Ullman NL, Mann S et al. Resolution of intraventricular hemorrhage varies by ventricular region and dose of intraventricular thrombolytic: the Clot Lysis: Evaluating Accelerated Resolution of IVH (CLEAR IVH) program. Stroke J Cereb Circ 2012; 43: 1666-1668
    CrossrefPubMedGoogle Scholar
  • 19 Morgan T, Awad I, Keyl P et al. Preliminary report of the clot lysis evaluating accelerated resolution of intraventricular hemorrhage (CLEAR-IVH) clinical trial. Acta Neurochir Suppl 2008; 105: 217-220
    PubMedGoogle Scholar
  • 20 Jaffe J, Melnychuk E, Muschelli J et al. Ventricular catheter location and the clearance of intraventricular hemorrhage. Neurosurgery 2012; 70: 1258-1263 ; discussion 1263–1264
    CrossrefPubMedGoogle Scholar
  • 21 Jackson DA, Patel AV, Darracott RM et al. Safety of intraventricular hemorrhage (IVH) thrombolysis based on CT localization of external ventricular drain (EVD) fenestrations and analysis of EVD tract hemorrhage. Neurocrit Care 2013; 19: 103-110
    CrossrefPubMedGoogle Scholar
  • 22 Volbers B, Wagner I, Willfarth W et al. Intraventricular fibrinolysis does not increase perihemorrhagic edema after intracerebral hemorrhage. Stroke J Cereb Circ 2013; 44: 362-366
    CrossrefPubMedGoogle Scholar
  • 23 Li Y, Zhang H, Wang X et al. Neuroendoscopic surgery versus external ventricular drainage alone or with intraventricular fibrinolysis for intraventricular hemorrhage secondary to spontaneous supratentorial hemorrhage: a systematic review and meta-analysis. PloSOne 2013; 8: e80599
    CrossrefPubMedGoogle Scholar
  • 24 Klimo P, Kestle JRW, MacDonald JD et al. Marked reduction of cerebral vasospasm with lumbar drainage of cerebrospinal fluid after subarachnoid hemorrhage. J Neurosurg 2004; 100: 215-224
    CrossrefPubMedGoogle Scholar
  • 25 Kwon OY, Kim YJ, Kim YJ et al. The Utility and Benefits of External Lumbar CSF Drainage after Endovascular Coiling on Aneurysmal Subarachnoid Hemorrhage. J Korean Neurosurg Soc 2008; 43: 281-287
    CrossrefPubMedGoogle Scholar
  • 26 Widenka DC, Wolf S, Schürer L et al. Factors leading to hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurol Neurochir Pol 2000; 34 (Suppl. 06) 56-60
    PubMedGoogle Scholar
  • 27 Al-Tamimi YZ, Bhargava D, Feltbower RG et al. Lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage: a prospective, randomized, controlled trial (LUMAS). Stroke J Cereb Circ 2012; 43: 677-682
    CrossrefPubMedGoogle Scholar
  • 28 Bardutzky J, Witsch J, Jüttler E et al. EARLYDRAIN- outcome after early lumbar CSF-drainage in aneurysmal subarachnoid hemorrhage: study protocol for a randomized controlled trial. Trials 2011; 12: 203
    CrossrefPubMedGoogle Scholar
  • 29 Huttner HB, Nagel S, Tognoni E et al. Intracerebral hemorrhage with severe ventricular involvement: lumbar drainage for communicating hydrocephalus. Stroke J Cereb Circ 2007; 38: 183-187
    CrossrefPubMedGoogle Scholar
  • 30 Staykov D, Huttner HB, Struffert T et al. Intraventricular fibrinolysis and lumbar drainage for ventricular hemorrhage. Stroke J Cereb Circ 2009; 40: 3275-3280
    CrossrefPubMedGoogle Scholar
  • 31 Huttner HB, Schwab S, Bardutzky J. Lumbar drainage for communicating hydrocephalus after ICH with ventricular hemorrhage. Neurocrit Care 2006; 5: 193-196
    CrossrefPubMedGoogle Scholar
  • 32 Speck V, Staykov D, Huttner HB et al. Lumbar catheter for monitoring of intracranial pressure in patients with post-hemorrhagic communicating hydrocephalus. Neurocrit Care 2011; 14: 208-215
    CrossrefPubMedGoogle Scholar
  • 33 Staykov D, Speck V, Volbers B et al. Early recognition of lumbar overdrainage by lumboventricular pressure gradient. Neurosurgery 2011; 68: 1187-1191 ; d1191
    CrossrefPubMedGoogle Scholar
  • 34 Zhang Z, Li X, Liu Y et al. Application of neuroendoscopy in the treatment of intraventricular hemorrhage. Cerebrovasc Dis Basel Switz 2007; 24: 91-96
    PubMedGoogle Scholar