External ventricular drainage and passive vs. active neurosurgical intervention in the management of hypertensive intracerebral hemorrhage with rupture into the ventricles.
The mortality rate of hypertensive intracerebral hemorrhages (HICH) with ventricular rupture (VR) has been said to range between 60 and 86%. We report on 33 consecutive cases of HICH associated with VR, which were diagnosed by CT and treated by external ventricular drainage (EVD). Sixteen hemorrhages were in the capsulolenticulostriate area, and 6 were in the posterior fossa. A modification of the usual system of severity grading for intraventricular hemorrhages (IVH) in posterior fossa bleedings is suggested. Extent of IVH correlated with neurological deficit on admission in 29 patients (87%) and with outcome in 26 patients (78%). Following passive neurosurgical policies in which the deterioration of patient's clinical situation indicates the craniotomy, only one intracerebral hematoma (ICH) was partially removed. Twelve patients (36.5%) died, and 12 of the survivors had no or only a minor neurological deficit. The results are compared with those of a series of patients, reported by Hayashi et al., who were treated according to active neurosurgical policies in which the largeness of ICH and IVH indicates the craniotomy, whereby it is concluded that active neurosurgical intervention does not reduce significantly the mortality and morbidity of HICH with VR. The pathophysiological explanation for this is discussed on the basis of a review of reference literature.
Taheri
S A
SA
Department of Neurosurgery, Steglitz Medical Center, Free University of Berlin, Berlin, FRG.
Wani
M A
MA
Lewko
J
J