Prevalence of Shunt Dependency and Clinical Outcome in Patients with Massive Intraventricular Haemorrhage Treated with Endoscopic Washout and External Ventricular Drainage
- Author:
Zamzuri Idris
;
Jafri Malin Abdullah
- Publication Type:Journal Article
- Keywords:
intraventricular haemorrhage, Graeb score, endoscopy, external ventricular drainage
- From:Malaysian Journal of Medical Sciences
2017;24(1):40-46
- CountryMalaysia
- Language:English
-
Abstract:
Background: Intraventricular haemorrhage (IVH) causes blockage of ventricular
conduits leading to hydrocephalus, increased intracranial pressure (ICP), and a reduced
level of consciousness. The current standard management of IVH is insertion of an external
ventricular drainage (EVD) catheter. However, this procedure addresses only the problems of
acute hydrocephalus and raised ICP. Endoscopic washout allows for a more complete removal
of the intraventricular clot. This study compared these two types of treatment in terms of shunt
dependency and relevant clinical outcomes.
Methods: Patients who were 10–80 years old and presented with a Graeb score of more
than six were randomised into endoscopic washout and EVD treatment groups. A CT brain was
repeated on each patient within 24 hours after surgery, and if a patient’s Graeb score was still
more than six, a repeat endoscopic washout was performed to clear the remaining clots. All
patients were monitored for shunt dependency at two weeks and three months, and clinical
outcomes were measured at six months after the procedure.
Results: A total of 39 patients were recruited; 19 patients were randomised into the
endoscopic washout group, and 20 were randomised into the EVD group. However, three patients
in the endoscopic group refused that treatment and opted for EVD insertion. Patients treated with
endoscopic washout had significantly less drainage dependency at two weeks (P < 0.005) and at
three months (P < 0.004) as compared to patients in the external ventricular drainage group.
The reduction in Graeb scores was also significantly greater in the endoscopic washout group
(P < 0.001). However, the functional outcome at six months measured via a modified Rankin scale
score was no different in the two groups of patients. The difference in the functional outcome of
the patients was mainly dependent on the initial pathology, with those presenting with a thalamic
bleed with IVH showing a poor functional outcome. This parameter was also influenced by the
Glasgow Coma Scale (GCS) score on admission, with those patients with a score of 12 or less
having a poor functional outcome (MRS 5–6) at three and six months after the surgery.
Conclusions: The use of neuroendoscopy in patients with a massive IVH significantly
reduced drainage dependency. However, it did not alter the final functional outcome.
- Full text:P020170313561865854739.pdf
