Interhemispheric transcorpus callosal approach in the treatment of ventricular hemorrhage with obstructive hydrocephalus.
BACKGROUND
Intraventricular hemorrhage, a frequent complication of intracerebral supratentorial hemorrhage, is associated with high rates of morbidity and mortality. Several methods have recently been developed for accelerating the clearance of intraventricular blood clots, especially during massive IVH. The present study was conducted to evaluate the interhemispheric, transcorpus callosal approach with septostomy for the management of supratentorial hemorrhage with intraventricular extension.


METHODS
Eighteen patients with primary IVH or thalamic/caudate hemorrhage complicated by IVH received an operation for removal of intraventricular blood clots by the interhemispheric, transcorpus callosal approach with septostomy. All patients received a brain CT examination before and after surgery. Clinical outcomes were assessed 6 months after surgery by the GOS.


RESULTS
Good clinical outcomes (GOS scores >or=4) were achieved in 45.6% of patients. In the patients with poor clinical outcome, the mean age was older (P=.001) and diabetes mellitus was more common (P=.04). Patients with thalamic hemorrhage with rupture into the third ventricle had worse clinical outcomes (P=.04). The overall mortality rate at 6 months postsurgery was 5.6%.


CONCLUSIONS
The interhemispheric, transcorpus callosal approach with septostomy is safe and effective for direct removal of intraventricular blood clots during treatment of supratentorial hemorrhage with intraventricular extension. Further investigations involving more cases are needed to assess more fully the extent of improvement in clinical outcome attributable to this approach.
Wang
Kuo-Chuan
KC
Department of Neurosurgery, National Taiwan University Hospital, Yulin, ROC Taiwan.
Lee
Jing-Er
JE
Chen
Chi-Lin
CL
Tseng
Sheng-Hong
SH
Kao
Min-Chien
MC
Chen
Jin-Cherng
JC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002552:Cerebral Ventricles; D003337:Corpus Callosum / Q000601:surgery*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D020300:Intracranial Hemorrhages / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D020665:Septum of Brain / Q000601:surgery; D016896:Treatment Outcome