Ventriculostomy and Lytic Therapy for Intracerebral Hemorrhage

Intraventricular hemorrhage (IVH) frequently complicates intracranial hemorrhage (ICH) and is a significant independent contributor to morbidity and mortality, yet therapy directed at ameliorating intraventricular clotting has been limited and until recently, has not been subject to systematic evaluation. Thrombolytic therapy with placement of an external ventricular drain for management of severe IVH secondary to ICH has been investigated in multiple observational studies, small randomized controlled trials and several meta-analyses, soon to culminate with the completion of the 500 patient CLEAR IVH randomized controlled trial. We review conventional and lytic therapeutic approaches to severe IVH in the setting of small ICH, articulating the scope of the problem, management issues, and relevant questions for future research.