The Effect of Constant Ventricular Drainage for the Patients of Intraventricular Hemorrhage.

Han, Yong Pyo

Original Article

Journal of Korean Neurosurgical Society 1974;3(2): 93-100.

Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Among all of the cerebrovascular problems that which has the highest mortality and worst prognosis is the problem of intraventricular hemorrhage. The mortality is highest immediately following the hemorrhage. Because direct surgical intervention is thought to be very dangerous in patients with intraventricular hemorrhage most of these patients have been treated conservatively. This study gives the results of evacuation of the intraventricular blood plus the placement of external draninage catheters which decrease the intraventricular pressure and provide and outlet for the blood should the patient have further hemorrhage. Such a procedure is associated with clinical improvement which better prepares such patients for subsequent surgical treatment. Eighteen patients who had intraventricular hemorrhage between June 1973 and April 1974 are analyzed as to the results of this operative treatment. Also the literature concerning this new method is reviewed. The operative procedure was as follows: Under local anesthesia using 1% procaine unilateral or bilateral burr holes were made in the frontal area. Ventriculostomy was made through these oles. The ventricle was irrigated with physiologic saline removing the hematoma or the bloody ventricular fluid. The irrigation was continued until the fluid became relatively clear. Following the initial irrigation, the cannular was removed and a Nelaton catheter placed into the ventricle. The catheter was fixed to the scalp and connected to a drainage bottle under aseptic conditions. The ventricular drainage was maintained at 200 mmH2O for 7-10 days. Prior to surgery 2 million units of procaine penicillin was injected into the ventricle. Postoperatively, 5mg of Gentamycin was injected through the catheter twice a day. Surgical drainage of the ventricle was done 3 hours to 7 days after the onset of clinical signs of hemorrhage. The external ventricular drainage was maintained for an average of 7.0 days. RESULTS: 10 patients(56%) improved and could be discharged. 4 died of recurrent intraventricular hemorrhage, of gastrointestinal bleeding, or of myocardial infarction during hospitalization. However, all of these 4 patients showed some clinical improvement following the operative procedure. Only "4" patients expired after surgery. This mortality of 44% is considerably less than the usually found mortality of 80-100% for intraventricular hemorrhage and 60-70% in subarachnoid hemorrhage. On the basis of this study a more active treatment of patients with intraventricular hemorrhage, including operative drainage of the ventricles is proposed.