Department of Neurosurgery, Tiemei General Hospital of Liaoning Health Industry Group, Tieling, China.
Department of Neurology, Binzhou Medical University Hospital, Binzhou, China.
World Neurosurg. 2022 Nov;167:e1317-e1324. doi: 10.1016/j.wneu.2022.09.020. Epub 2022 Sep 9.
Intraventricular hemorrhage (IVH) is one of the most fatal types of intracerebral hemorrhage (ICH), especially when the third and the fourth ventricles are involved. The use of external ventricular drainage is limited for evacuation of hemorrhage in the lateral ventricles. Endoscopic surgery can provide visualized evacuation of the hemorrhage in the lateral and third ventricles. However, it is usually challenging to access the fourth ventricle using a routine endoscopic approach.
We have reported 3 cases of severe IVH with cast fourth ventricles treated using an endoscopic-assisted trans-lateral ventricular transchoroidal fissure trans-aqueductal approach.
The average preoperative Graeb score was 11, and the average IVH volume was 75.12 mL. The IVH evacuation rate was 97.5%-100%. The average Glasgow coma scale score had increased to 12 at discharge from 6.6 at admission. At 3 months after surgery, the average modified Rankin scale score was 3. No cerebrospinal fluid shunt had been required and no surgery-related complication had occurred in any patient.
Our results have shown that the endoscopic-assisted trans-lateral ventricular transchoroidal fissure trans-aqueductal approach is a feasible and safe endoscopic option that can achieve one-off complete removal of clots in all 4 ventricles in patients with severe IVH.
脑室内出血（IVH）是最致命的脑出血（ICH）类型之一，尤其是当第三和第四脑室受累时。外引流术对侧脑室出血的清除效果有限。内镜手术可提供可视化的侧脑室和第三脑室出血清除。然而，通常使用常规内镜方法难以进入第四脑室。
我们报告了 3 例严重 IVH 合并第四脑室铸型的病例，采用内镜辅助经侧脑室经脉络丛裂经导水管入路治疗。
平均术前 Graeb 评分 11 分，平均 IVH 量 75.12mL。IVH 清除率为 97.5%-100%。格拉斯哥昏迷评分（GCS）从入院时的 6.6 分增加到出院时的 12 分。术后 3 个月，平均改良 Rankin 量表评分为 3 分。所有患者均未行脑脊液分流术，无手术相关并发症。
我们的结果表明，内镜辅助经侧脑室经脉络丛裂经导水管入路是一种可行且安全的内镜选择，可一次性彻底清除严重 IVH 患者 4 个脑室的血栓。
