title: External ventricular drainage alone versus endoscopic surgery for severe intraventricular hemorrhage: a comparative retrospective analysis on outcome and shunt dependency.
abstract: OBJECTIVE
  Massive intraventricular hemorrhages (IVHs) require aggressive and rapid management to decrease intracranial hypertension, because the amount of intraventricular blood is a strong negative prognostic predictor on outcome. Neuroendoscopy may offer some advantages over more traditional surgical approaches on outcome and may decrease the number of shunt procedures that need to be performed.
  
  
  METHODS
  The authors retrospectively reviewed the clinical and radiological data in 96 patients treated for massive IVH who were admitted between January 1996 and June 2008 to the neurosurgery unit after undergoing emergency CT scanning. Forty-eight patients (Group A) were treated with endoscopic aspiration surgery using a flexible endoscope with a "freehand" technique. A historical group of 48 patients (Group B) treated using external ventricular drain (EVD) placement alone was used as a comparison. The authors compared the radiological results with the clinical outcomes at 1 year according to the modified Rankin Scale and the need for internal CSF shunt treatment in the 2 groups.
  
  
  RESULTS
  Endoscopic aspiration did not significantly affect the outcome at 1 year as determined using the modified Rankin Scale. Patients who underwent endoscopy had an EVD in place for 0.18 days fewer than patients treated with an EVD alone. Patients undergoing external ventricular drainage alone had a 5 times greater chance of requiring a shunting procedure than those treated using neuroendoscopy and external ventricular drainage. Neuroendoscopy plus external drainage reduces shunting rates by 34% when compared with external drainage alone.
  
  
  CONCLUSIONS
  The reduction in internal shunt surgery encourages the adoption of neuroendoscopic aspiration of severe IVH as a therapeutic tool to decrease shunt dependency.
authors.affiliation: Department of Neurosurgery, Treviso Regional Hospital, University of Padova, Treviso, Italy. lbasaldella@ulss.tv
authors.forename: Luca
authors.initials: L
authors.lastname: Basaldella
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Marton
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fiorindi
authors.forename: Bruno
authors.initials: B
authors.lastname: Scarpa
authors.forename: Hadi
authors.initials: H
authors.lastname: Badreddine
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Longatti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery*; D002552:Cerebral Ventricles / Q000601:surgery*; D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D002648:Child; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult