Department of Neurosurgery, Caen University Hospital, Avenue de la Cote de Nacre, Caen, 14000, France.
Neurosurg Rev. 2012 Oct;35(4):485-94; discussion 494-5. doi: 10.1007/s10143-012-0399-9. Epub 2012 Jun 26.
Intraventricular hemorrhage (IVH) is defined as the eruption of blood in the cerebral ventricular system and is mostly secondary to spontaneous intracerebral hemorrhage and aneurysmal and arteriovenous malformation rupture. IVH is a proven risk factor of increased mortality and poor functional outcome. Its seriousness is correlated not only with the amount of blood but also with the involvement of the third and fourth ventricles. There are four mechanisms that explain the pathophysiology of this event: acute obstructive hydrocephalus, the mass effect exerted by the blood clot, the toxicity of blood-breaking products on the adjacent brain parenchyma, and, lastly, the development of a chronic hydrocephalus. It is thus obvious that the clearance of blood from the ventricles should be a therapeutic goal. In cases of acute hydrocephalus, external ventricular drainage is a mandatory step, but proven often insufficient. The concomitant use of intraventricular fibrinolytics such as recombinant tissue plasminogen activator or urokinase seems to be beneficial at least in the context of spontaneous intracerebral hemorrhage, in which their use is now accepted but not yet validated by a randomized trial. Given the potential neurotoxicity of these agents, further research is needed in order to identify the best treatment for intraventricular fibrinolysis (IVF). The endoscopic retrieval of intraventricular blood was also described recently and seems to be as efficient as IVF, but its use is limited to specialized centers. IVH represents a therapeutic challenge for neurosurgeons, neurologists, and intensivists. Thus, a better understanding of this dramatic event will help in better tailoring the treatment strategies.
脑室内出血（IVH）定义为血液在脑室内系统中的喷发，主要继发于自发性脑出血和动脉瘤及动静脉畸形破裂。IVH 是增加死亡率和不良功能预后的已知危险因素。其严重程度不仅与出血量有关，还与第三和第四脑室的受累程度有关。有四种机制可以解释这种事件的病理生理学：急性梗阻性脑积水、血栓形成的物质效应、血液分解产物对邻近脑实质的毒性作用，以及慢性脑积水的发展。因此，从脑室清除血液应该是一个治疗目标。在急性脑积水的情况下，外部脑室引流是强制性的步骤，但往往证明是不够的。联合使用重组组织纤溶酶原激活剂或尿激酶等脑室内溶栓药物至少在自发性脑出血的情况下似乎是有益的，现在已经接受了这些药物的使用，但还没有随机试验验证。鉴于这些药物潜在的神经毒性，需要进一步研究以确定脑室内溶栓（IVF）的最佳治疗方法。最近还描述了脑室内血液的内镜清除术，其似乎与 IVF 一样有效，但它的使用仅限于专门的中心。IVH 对神经外科医生、神经科医生和重症监护医生来说是一个治疗挑战。因此，更好地理解这一戏剧性事件将有助于更好地调整治疗策略。
