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| Neuroendoscopic channel interior technique treats severe intraventricular hemorrhage |
| Du Bo,Peng Yu-ping, Zhong Xian-liang, Wang Jin, Hao Wen-wen, Xu Jian-zhong, Lv Wen, Shan Ai-jun |
| Department of Emergency, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, China |
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Abstract Objective To explore the application value, technical key points and operation experience of neuroendoscopic channel interior technique in the treatment of severe intraventricular hemorrhage.Methods Thirty- two cases with severe intraventricular hemorrhage（IVH）treated by neuroendoscopic channel interior technique were analyzed and the patients were from Emergency Department of Shenzhen People's Hospital and Neurosurgery Department of Nanfang Hospital from July 2013 to January 2016. The research cases included 11 cases with total IVH, 9 cases with bilateral ventricular and third ventricle hematoma, 7 cases with unilateral lateral ventricle, the third ventricle andthe fourth ventricle hematoma, 5 cases with unilateral lateral ventricle and the third ventricle hematoma. CT/CTA scans were done before operations. The average hematoma volume was（75.6±12.5）mL; Graeb score was 6～12, Glasgow coma score（GCS）was 5～12. All patients were received neuroendoscopic channel interior technique treatment and some patients with fourth ventricle hematoma received external drainage of lumbar cistern additionally. Record and compare the diameters before and after operation, such as IVH volume,Graeb score, GCS score, etc. Results CT scans showed that the lateral ventricle and the third ventricle were almost completely removed after neuroendoscopic channel interior tech⁃ nique operation immediately and the average hematoma clearance time of the fourth ventricle was 2～4 days after the lumbar cistern drainage. There were 4 cases occurred cerebrospinal fluid leakage, 2 cases got intracranial infection and 8 cases had pneumocrania. Fortunately, no rebleeding and drainage tube blocking cases found in this study. We recorded that the time of removing ventricular drainage tubes was 2～3 days,the tube removing time of lumbar cistern drainage was 3～4 days and the ICU staying time was 4～6days. A 3 cm base small arc skin flap and a 0.8 to 1.1 cm bone window were needed during the operation.The intraoperative blood loss was 20 to 50 mL with a mean of 30 mL and the operation time was 45 to 110 minutes with a mean of 65 minutes. The Glasgow outcome scale（GOS）score 3 months after the operation revealed: 21 patients recovered well, 6 cases had mild disability, 5 cases had severe disability and no died cases. Conclusion Neuroendoscopic channel interior technique treats severe ven⁃ tricular hemorrhage just need one skull hole can complete the operation and practicing processing proved excellent performance of convenient operation, small trauma, quick recovery and little complications. Technical points: the puncture position is located in the lateral ventricle frontal horn and make full use of the transparent sheath and hematoma smashing suction apparatus. The negative suction pressure is different between the lateral ventricles and the third ventricle. Using suction / broken suction to clear lateral ventricle's hematoma, and to the hematoma in the third ventricle, firstly, using low negative pressure to drag the hematoma out of interventricular foramen and then using relatively higher negative pressure to remove. The operation in the third ventricle should avoid damage/stimulate the hypothalamus and the hematoma should be removed as much as possible under safety
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Received: 11 April 2016
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Corresponding Authors:
shanaij@yeah.net
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