title: Endoscopic surgery for intraventricular hemorrhage (IVH) caused by thalamic hemorrhage: comparisons of endoscopic surgery and external ventricular drainage (EVD) surgery.
abstract: BACKGROUND
  Intraventricular hemorrhage (IVH) caused by thalamic hemorrhage has high mortality and morbidity. The aim of this study was to investigate the efficacy and the results of endoscopic surgery for the evacuation of IVH caused by thalamic hemorrhage compared with that of external ventricular drainage (EVD) surgery.
  
  
  METHODS
  From January 2006 to December 2008, 48 patients with IVH caused by thalamic hemorrhage were enrolled and treated in our department. Patients with IVH caused by thalamic hemorrhage who also resulted in acute hydrocephalus were indicated for surgery; the patients who were included were randomly divided into an EVD group and an endoscopic surgery group. The clinical evaluation data included the Glasgow Coma Scale, length of intensive care unit (ICU) stay, age, intracerebral hemorrhage volume, and severity of IVH. Outcome was measured using the 30-day and 90-day mortality rate, ventriculoperitoneal (VP) shunt dependent rate, and Glasgow Outcome Scale after three months.
  
  
  RESULTS
  The clinical features of the 24 patients in each group showed no significant differences in age or Glasgow Coma Scale assessment on admission. There was also no significant difference in intracerebral hemorrhage volume or Graeb score between the endoscopic group and the EVD group. The length of ICU stay was 11 ± 5 days in the endoscopic surgery group and 18 ± 7 days in the EVD group. The endoscopic surgery group had a shorter ICU stay (P = 0.04) compared with the EVD group. The 30-day and 90-day mortality rates were 12.5% and 20.8% in the endoscopic surgery group and 12.5% and 16.6% in the EVD group, respectively. The mean Glasgow Outcome Scale score was 3.08 ± 1.38 in the endoscopic surgery group and 3.33 ± 1.40 in the EVD group. Outcome significantly correlated with initial consciousness level; the severity of IVH did not influence the outcome in all of the cases. There was no significant difference in mortality rate or outcome between the endoscopic group and the EVD group. The VP shunt rates were 47.62% in the endoscopic surgery group and 90.48% in the EVD group. Endoscopic surgery group had a significant lower VP shunt rate (P = 0.002; odds rate = 9.8) compared with the EVD group.
  
  
  CONCLUSIONS
  Endoscopic surgery was found to have significantly lower shunt-dependent hydrocephalus, and the ICU stay was shorter compared with EVD surgery. This can decrease the need for permanent VP shunts in patients with IVH caused by thalamic hemorrhage.
authors.affiliation: Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan, Republic of China. cck36701@ms21.hinet.net
authors.forename: Chun-Chung
authors.initials: CC
authors.lastname: Chen
authors.forename: Chun-Lin
authors.initials: CL
authors.lastname: Liu
authors.forename: Ying-Nan
authors.initials: YN
authors.lastname: Tung
authors.forename: Han-Chung
authors.initials: HC
authors.lastname: Lee
authors.forename: Hao-Che
authors.initials: HC
authors.lastname: Chuang
authors.forename: Shinn-Zong
authors.initials: SZ
authors.lastname: Lin
authors.forename: Der-Yang
authors.initials: DY
authors.lastname: Cho
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000401:mortality / Q000601:surgery*; D002552:Cerebral Ventricles / Q000601:surgery; D004724:Endoscopy / Q000379:methods* / Q000401:mortality; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006849:Hydrocephalus / Q000401:mortality / Q000601:surgery; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods* / Q000401:mortality; D013788:Thalamus / Q000098:blood supply*; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000401:mortality