Neuroendoscopic removal of intraventricular hemorrhage combined with hydrocephalus

The neuroendoscope is playing an increasing role in the diagnosis and treatment of several types of lesions, in particular in the ventricular system. Hydrocephalus associated with intraventricular hemorrhage (IVH) is a good indication for neuroendoscopic surgery. We describe herein our experiences with 17 cases of IVH combined with hydrocephalus treated using a neuroendoscope.

The subjects comprised 17 patients with IVH combined with hydrocephalus treated in our department, including cases of thalamic hemorrhage (n=10), caudate hemorrhage (n=5), moya-moya disease (n=1), and dural arteriovenous fistula (n=1). We used a flexible fiberscope that was inserted into the anterior horn of the lateral ventricle. Hematoma was easily evacuated through the working channel of the neuroendoscope by manual maneuvers. Hematomas in the third ventricle, aqueduct and fourth ventricle could also be evacuated. With the addition of septostomy, hematomas in the contralateral lateral ventricle could also be evacuated.

All patients underwent successful procedures with good outcomes. No permanent morbidity and mortality was associated with any neuroendoscopic procedures. Shunt insertion was required in 3 cases due to malabsorption of cerebrospinal fluid (CSF) in the chronic stage.

Neuroendoscopic procedures with a flexible fiberscope for the removal of IVH allow resolution of the disturbed CSF circulation. This procedure improves the safety and accuracy of treatment for IVH combined with hydrocephalus.