Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
World Neurosurg. 2021 Jun;150:e771-e776. doi: 10.1016/j.wneu.2021.03.142. Epub 2021 Apr 2.
Severe intraventricular hemorrhage (IVH) is associated with a high mortality rate and poor functional outcome, even with recent neurosurgical developments. IVH requires emergent surgery to save the patient's life, but the optimal surgical strategy remains controversial. We assessed the results obtained with our tailor-made endoscopic surgical strategy for severe IVH with obstructive hydrocephalus.
Consecutive patients with severe IVH owing to intracerebral hemorrhage who were treated with endoscopic surgery in the acute phase were retrospectively reviewed. Both rigid and flexible endoscopes were used for removal of hematoma in the whole ventricular system. Endoscopic third ventriculostomy and septostomy were performed as appropriate in each individual case.
Eight patients met the inclusion criteria and were included in the analysis. Sufficient IVH removal without neglecting the fourth ventricle was achieved with our technique in 6 of 8 cases (75.0%). Endoscopic third ventriculostomy and septostomy were added in 4 cases each (50.0%). Four patients (50.0%) had a marked recovery and a good outcome (modified Rankin Scale score ≤2) despite disease severity at onset. The procedure was completed successfully in all cases, and there were no surgery-related complications.
This study showed that our tailor-made endoscopic surgical strategy for severe IVH with obstructive hydrocephalus may be beneficial.
即使在最近神经外科发展的情况下，严重的脑室内出血（IVH）仍然与高死亡率和较差的功能预后相关。IVH 需要紧急手术来挽救患者的生命，但最佳手术策略仍存在争议。我们评估了我们针对伴有梗阻性脑积水的严重 IVH 采用的定制内镜手术策略的结果。
回顾性分析了接受急性内镜手术治疗的因脑出血导致严重 IVH 的连续患者。我们使用硬镜和软镜清除整个脑室系统的血肿。在每个病例中均酌情进行内镜第三脑室造瘘和室间隔造瘘术。
8 例符合纳入标准并纳入分析。6 例（75.0%）患者采用我们的技术实现了充分清除 IVH 而不忽视第四脑室。4 例（50.0%）患者分别进行了内镜第三脑室造瘘和室间隔造瘘术。尽管发病时病情严重，但仍有 4 例（50.0%）患者明显恢复且预后良好（改良Rankin 量表评分≤2）。所有病例均成功完成手术，无手术相关并发症。
本研究表明，我们针对伴有梗阻性脑积水的严重 IVH 的定制内镜手术策略可能有益。
