title: Safety and feasibility of combined coiling and neuroendoscopy for better outcomes in the treatment of severe subarachnoid hemorrhage accompanied by massive intraventricular hemorrhage.
abstract: Subarachnoid hemorrhage (SAH) with intraventricular hemorrhage (IVH) is associated with poor outcomes. The aim of this study was to evaluate the safety and feasibility of combined coiling and neuroendoscopy for treating severe SAH with massive IVH. Between April 2008 and June 2011, 49 patients with a severe SAH were treated at the Department of Neurosurgery, Fukuoka University, Japan; 10 of these patients had a massive IVH with a ruptured aneurysm. All 10 patients (three men and seven women; mean age, 63.1±8.5 years) were treated with coiling and neuroendoscopic removal of the IVH within 2 days of onset. Coiling was successfully performed at a mean volume embolization ratio of 21.8±5.5%. Neuroendoscopic removal of the IVH reduced the mean Graeb score from 10.5±2.0 to 4.8±2.5 (p=0.005). All external drains were removed on day 3. No rebleeding or acute hydrocephalus was noted. The Glasgow Outcome Scale scores at discharge indicated two patients with good recovery, three with moderate disability, four in a vegetative state, and one dead. A good modified Rankin Scale (mRS) score (0-2) at least 6 months later (mean follow-up period, 15.4±9.2 months) was observed for five patients (50%), and a poor mRS score (3-6) was observed for the remaining four patients. Neuroendoscopically removing the IVH from all of the ventricles between the lateral and the fourth ventricle and coiling the ruptured aneurysm is a safe, feasible approach for treating severe SAH with massive IVH.
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jounan-ku, Fukuoka City, Fukuoka 814-0180, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Iwaasa
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ueba
authors.forename: Masani
authors.initials: M
authors.lastname: Nonaka
authors.forename: Masakazu
authors.initials: M
authors.lastname: Okawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Abe
authors.forename: Toshio
authors.initials: T
authors.lastname: Higashi
authors.forename: Tooru
authors.initials: T
authors.lastname: Inoue
mesh_terms: D000368:Aged; D002552:Cerebral Ventricles / Q000601:surgery*; D014695:Cerebral Ventriculography / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Coiling; Intraventricular hemorrhage; Modified Rankin scale; Neuroendoscopy; Subarachnoid hemorrhage