Longatti P L, Martinuzzi A, Fiorindi A, Maistrello L, Carteri A
Neurosurgery Unit, Department of Neuroscience, Treviso Hospital, Treviso, Italy.
Stroke. 2004 Feb;35(2):e35-8. doi: 10.1161/01.STR.0000113736.73632.F6. Epub 2004 Jan 22.
We reviewed our 7-year experience in neuroendoscopic management of severe intraventricular hemorrhage (IVH) to evaluate its safety, efficiency, and efficacy.
Thirteen patients with spontaneous primary or secondary tetraventricular IVH underwent neuroendoscopy. In all procedures, we used a flexible instrument. CT scans obtained before and after surgery were compared for Graeb score and ventriculocranial ratio. Glasgow Outcome Scale was assessed at 12 months.
In all patients, the procedure resulted in a substantial removal of ventricular blood. Graeb score was reduced by 65%, and ventriculocranial ratio was reduced by 30% (P<0.002). The procedure was carried out safely even in the presence of a vascular malformation, and no rebleeding or delayed hydrocephalus was observed in any case. Mortality at 12 months was 30.7%. Favorable outcome (Glasgow Outcome Scale, 3 to 5) was observed in 61.5% of cases.
Neuroendoscopic management of severe IVH in this cohort of patients was safe, efficiently reduced the amount of ventricular blood and ventricular dilatation, and effectively produced an outcome profile that compares very favorably with other more conventional treatments.
我们回顾了7年来应用神经内镜治疗严重脑室内出血（IVH）的经验，以评估其安全性、有效性和疗效。
13例自发性原发性或继发性四脑室IVH患者接受了神经内镜治疗。所有手术均使用软性器械。比较手术前后CT扫描的Graeb评分和脑室颅比。在12个月时评估格拉斯哥预后量表。
所有患者术后脑室内血液均大量清除。Graeb评分降低65%，脑室颅比降低30%（P<0.002）。即使存在血管畸形，手术也能安全进行，且未观察到任何再出血或迟发性脑积水病例。12个月时死亡率为30.7%。61.5%的病例获得了良好预后（格拉斯哥预后量表评分，3至5分）。
在该组患者中，神经内镜治疗严重IVH安全有效，能有效减少脑室内积血和脑室扩张，并显著改善预后，与其他更传统的治疗方法相比具有很大优势。
