title: Clearing bloody cerebrospinal fluid: clot lysis, neuroendoscopy and lumbar drainage.
abstract: OBJECTIVE
  Bloody cerebrospinal fluid (CSF) is a major cause of morbidity and mortality in intraventricular hemorrhage (IVH) and subarachnoid hemorrhage (SAH). Different treatment strategies aiming at faster clearance of bloody CSF have emerged. The present review focuses on recent developments in the investigation of those treatments.
  
  
  RESULTS
  Intraventricular fibrinolysis (IVF) for accelerated IVH-resolution has been clinically tested since the early 1990s. The lately summarized evidence from smaller studies indicates that IVF may result in a benefit in mortality and outcome. Recent investigations have elucidated different aspects of IVF, mainly related to safety. Neuroendoscopy has also emerged as a minimally invasive technique allowing fast removal of IVH. The capability of lumbar drainage to reduce vasospasm after SAH has been tested in a large trial.
  
  
  CONCLUSIONS
  IVF is relatively well tolerated and accelerates clot clearance after IVH. The effect of IVF on clinical outcome and mortality is currently being investigated in a large-scale phase III clinical trial. Neuroendoscopy is feasible for the treatment of IVH, however, larger trials are lacking. Lumbar drainage reduces the incidence of vasospasm after SAH. An ongoing phase III trial has been designed to test its influence on outcome. Lumbar drainage may also reduce shunt-dependency after IVH.
authors: Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany. dimitre.staykov@uk-erlangen.de
authors: Dimitre
authors: D
authors: Staykov
authors: Stefan
authors: S
authors: Schwab
mesh_terms: D002543:Cerebral Hemorrhage / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D017326:Clinical Trials, Phase III as Topic; D004322:Drainage; D005260:Female; D063285:Fibrin Clot Lysis Time; D005342:Fibrinolysis; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D044583:Neuroendoscopy / Q000379:methods*; D013345:Subarachnoid Hemorrhage / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000517:prevention & control / Q000628:therapy*; D017287:Ventriculoperitoneal Shunt / Q000379:methods*
chemical_list: D005343:Fibrinolytic Agents