Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan, Republic of China.
World Neurosurg. 2011 Feb;75(2):264-8. doi: 10.1016/j.wneu.2010.07.041.
Intraventricular hemorrhage (IVH) caused by thalamic hemorrhage has high mortality and morbidity. The aim of this study was to investigate the efficacy and the results of endoscopic surgery for the evacuation of IVH caused by thalamic hemorrhage compared with that of external ventricular drainage (EVD) surgery.
From January 2006 to December 2008, 48 patients with IVH caused by thalamic hemorrhage were enrolled and treated in our department. Patients with IVH caused by thalamic hemorrhage who also resulted in acute hydrocephalus were indicated for surgery; the patients who were included were randomly divided into an EVD group and an endoscopic surgery group. The clinical evaluation data included the Glasgow Coma Scale, length of intensive care unit (ICU) stay, age, intracerebral hemorrhage volume, and severity of IVH. Outcome was measured using the 30-day and 90-day mortality rate, ventriculoperitoneal (VP) shunt dependent rate, and Glasgow Outcome Scale after three months.
The clinical features of the 24 patients in each group showed no significant differences in age or Glasgow Coma Scale assessment on admission. There was also no significant difference in intracerebral hemorrhage volume or Graeb score between the endoscopic group and the EVD group. The length of ICU stay was 11 ± 5 days in the endoscopic surgery group and 18 ± 7 days in the EVD group. The endoscopic surgery group had a shorter ICU stay (P = 0.04) compared with the EVD group. The 30-day and 90-day mortality rates were 12.5% and 20.8% in the endoscopic surgery group and 12.5% and 16.6% in the EVD group, respectively. The mean Glasgow Outcome Scale score was 3.08 ± 1.38 in the endoscopic surgery group and 3.33 ± 1.40 in the EVD group. Outcome significantly correlated with initial consciousness level; the severity of IVH did not influence the outcome in all of the cases. There was no significant difference in mortality rate or outcome between the endoscopic group and the EVD group. The VP shunt rates were 47.62% in the endoscopic surgery group and 90.48% in the EVD group. Endoscopic surgery group had a significant lower VP shunt rate (P = 0.002; odds rate = 9.8) compared with the EVD group.
Endoscopic surgery was found to have significantly lower shunt-dependent hydrocephalus, and the ICU stay was shorter compared with EVD surgery. This can decrease the need for permanent VP shunts in patients with IVH caused by thalamic hemorrhage.
由丘脑出血引起的脑室内出血（IVH）死亡率和发病率均较高。本研究旨在探讨与外部脑室引流（EVD）手术相比，内镜手术清除由丘脑出血引起的 IVH 的效果和结果。
自 2006 年 1 月至 2008 年 12 月，我科收治 48 例由丘脑出血引起的 IVH 患者。有 IVH 由丘脑出血引起且伴有急性脑积水的患者需要手术治疗；将患者随机分为 EVD 组和内镜手术组。临床评估数据包括格拉斯哥昏迷量表、重症监护病房（ICU）住院时间、年龄、脑出血量和 IVH 严重程度。结果采用 30 天和 90 天死亡率、脑室-腹膜（VP）分流依赖性率和三个月后的格拉斯哥结局量表进行测量。
每组 24 例患者的临床特征在年龄或入院时格拉斯哥昏迷量表评估方面无显著差异。内镜组与 EVD 组的脑出血量或 Graeb 评分也无显著差异。内镜手术组 ICU 住院时间为 11±5 天，EVD 组为 18±7 天。内镜手术组 ICU 住院时间较短（P=0.04）。内镜手术组 30 天和 90 天死亡率分别为 12.5%和 20.8%，EVD 组分别为 12.5%和 16.6%。内镜手术组平均格拉斯哥结局量表评分为 3.08±1.38，EVD 组为 3.33±1.40。结果与初始意识水平显著相关；所有病例 IVH 严重程度均不影响结果。内镜组和 EVD 组死亡率或结果无显著差异。内镜手术组 VP 分流率为 47.62%，EVD 组为 90.48%。内镜手术组 VP 分流率明显低于 EVD 组（P=0.002；优势比=9.8）。
与 EVD 手术相比，内镜手术发现明显降低了分流依赖性脑积水的发生率，且 ICU 住院时间更短。这可以降低由丘脑出血引起的 IVH 患者对永久性 VP 分流的需求。
