Endoscopic management of hypertensive intraventricular haemorrhage with obstructive hydrocephalus.
BACKGROUND
Intracranial haemorrhage accounts for 30-60 % of all stroke admissions into a hospital, with hypertension being the main risk factor. Presence of intraventricular haematoma is considered a poor prognostic factor due to the resultant obstruction to CSF and the mass effect following the presence of blood resulting in raised intracranial pressure and hydrocephalus. We report the results following endoscopic decompression of obstructive hydrocephalus and evacuation of haematoma in patients with hypertensive intraventricular haemorrhage.


METHODS
During a two year period, 25 patients diagnosed as having an intraventricular haemorrhage with obstructive hydrocephalus secondary to hypertension were included in this study. All patients underwent endoscopic evacuation of the haematoma under general anaesthesia. Post operative evaluation was done by CT scan and Glasgow outcome scale.


RESULTS
Of the 25 patients, thalamic haemorrhage was observed in 12 (48%) patients, while, 11 (44%) had a putaminal haematoma. Nine (36%) patients had a GCS of 8 or less pre-operatively. Resolution of hydrocephalus following endoscopic evacuation was observed in 24 (96%) patients. No complications directly related to the surgical technique were encountered in our study. At six months follow-up, a mortality rate of 6.3% and 55.5% was observed in patients with a pre-operative GCS of > or = 9 and < or = 8 respectively. Thirteen of the 16 (81.3%) patients with a pre-operative GCS >/= 9 had good recovery.


CONCLUSIONS
Endoscopic technique offers encouraging results in relieving hydrocephalus in hypertensive intraventricular haemorrhage. Final outcome is better in patient with a pre-operative GCS of >9. Future improvements in instrumentation and surgical techniques, with careful case selection may help improve outcome in these patients.
Yadav
Yad Ram
YR
NSCB Medical College and Hospital, Jabalpur, India. yadavyr@yahoo.co.in
Mukerji
Gaurav
G
Shenoy
Ravikiran
R
Basoor
Abhijeet
A
Jain
Gaurav
G
Nelson
Adam
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002552:Cerebral Ventricles / Q000503:physiopathology / Q000601:surgery*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods; D011446:Prospective Studies; D011859:Radiography