title: Application of the Ommaya Reservoir in Managing Ventricular Hemorrhage.
abstract: Intraventricular hemorrhage (IVH) is associated with high morbidity and mortality. This study evaluated the safety and efficacy of the combined treatment of an Ommaya reservoir and conventional external ventricular drainage (EVD) using urokinase in the management of IVH.
  
  
  
  We performed a prospective controlled study. Sixty eligible patients with IVH received conventional EVD alone (group A) or combined EVD and Ommaya reservoir (group B) between January 2010 and January 2015. Clinical, cerebrospinal fluid, and radiographic data were used to assess clot clearance, clinical outcomes, and complications between the groups.
  
  
  
  There were no significant differences in gender, age, blood pressure, Glasgow Coma Scale, Graeb score, intracerebral hemorrhage volume on admission, and IVH volume before surgery between groups A and B (P > 0.05). The number of injections of urokinase (20,000 IU/dose) were significantly different in group B compared with group A (P < 0.05). Repeated computed tomography scans 3 days, 6 days, and 10 days after surgery revealed that clot clearance rates at each time point were significantly increased in group B compared with group A (P < 0.05). The conventional catheter-based EVD duration time was shortened to 5 (4-6) days in group B compared with 7 (5-9) days in group A (P < 0.05). The total drainage time was prolonged to 9 (8-11) days in group B compared with 7 (5-9) days in group A (P < 0.05). Ventriculitis was not significantly different between the 2 groups (P > 0.05). The hydrocephalus incidence and mortality revealed significant differences between the 2 groups (P < 0.05). The 30-day Glasgow Outcome Scale score was significantly increased in group B compared with group A (P < 0.05).
  
  
  
  The combined treatment approach of an Ommaya reservoir and EVD with intraventricular urokinase is safe and effective in patients with IVH. It increased clot clearance, shortened conventional catheter-based EVD duration, prolonged total drainage time, reduced the hydrocephalus incidence and mortality, and contributed to good clinical outcomes. The Ommaya reservoir provides a safe way to increase the injection times of urokinase, which accelerated clot resolution and did not increase the risk for ventriculitis infection.
authors.affiliation: Department of Neurosurgery, No. 9 People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Xi-Tao
authors.initials: XT
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, No. 9 People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Dong-Fu
authors.initials: DF
authors.lastname: Feng
authors.affiliation: Department of Neurosurgery, No. 9 People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Neurosurgery, No. 9 People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Zhao-Liang
authors.initials: ZL
authors.lastname: Sun
authors.affiliation: Emergency Department and Trauma Center, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. Electronic address: shzhaogang@qq.com.
authors.forename: Gang
authors.initials: G
authors.lastname: Zhao
mesh_terms: D057785:Catheters / Q000009:adverse effects; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D002552:Cerebral Ventricles / Q000000981:diagnostic imaging / Q000187:drug effects / Q000601:surgery; D058565:Cerebral Ventriculitis / Q000209:etiology; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D004322:Drainage / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015600:Glasgow Coma Scale; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D007276:Injections, Intraventricular / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013530:Surgical Wound Infection; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator
keywords: External ventricular drainage; Ommaya reservoir; Urokinase; Ventricular hemorrhage