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      Therapy management and outcome of acute hydrocephalus secondary to intraventricular hemorrhage in adults

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          Abstract

          Background

          Intraventricular hemorrhage (IVH) refers to bleeding within the brain’s ventricular system, and hydrocephalus is a life-threatening complication of IVH characterized by increased cerebrospinal fluid accumulation in the ventricles resulting in elevated intracranial pressure. IVH poses significant challenges for healthcare providers due to the complexity of the underlying pathophysiology and lack of standardized treatment guidelines. Herein, we performed a systematic review of the treatment strategies for hydrocephalus secondary to IVH.

          Methods

          This systematic review was prospectively registered with PROSPERO (CRD42023450786). The search was conducted in PubMed, Cochrane Library, and Web of Science on July 15, 2023. We included original studies containing valid information on therapy management and outcome of hydrocephalus secondary to primary, spontaneous, and subarachnoid or intracranial hemorrhage following IVH in adults that were published between 2000 and 2023. Glasgow Outcome Scale (GOS) or modified Ranking Scale (mRS) scores during follow-up were extracted as primary outcomes. The risk of bias was assessed using the Newcastle–Ottawa Scale for Cohort Studies or Cochrane Risk of Bias 2.0 Tool.

          Results

          Two hundred and seven patients from nine published papers, including two randomized controlled trials, were included in the analysis. The GOS was used in five studies, while the mRS was used in four. Seven interventions were applied, including craniotomy for removal of hematoma, endoscopic removal of hematoma with/without endoscopic third ventriculostomy (ETV), traditional external ventricular drainage (EVD), and various combinations of EVD, lumbar drainage (LD), and intraventricular fibrinolysis (IVF). Endoscopic removal of hematoma was performed in five of nine studies. Traditional EVD had no obvious benefit compared with new management strategies. Three different combinations of EVD, LD, and IVF demonstrated satisfactory outcomes, although more studies are required to confirm their reliability. Removal of hematoma through craniotomy generated reliable result. Generally, endoscopic removal of hematoma with ETV, removal of hematoma through craniotomy, EVD with IVF, and EVD with early continuous LD were useful.

          Conclusion

          EVD is still crucial for the management of IVH and hydrocephalus. Despite a more reliable result from the removal of hematoma through craniotomy, a trend toward endoscopic approach was observed due to a less invasive profile.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s41016-024-00369-0.

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          Most cited references35

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          Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial

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            Global and domain-specific cognitive impairment and outcome after subarachnoid hemorrhage.

            Cognitive dysfunction is the most common form of neurologic impairment after subarachnoid hemorrhage (SAH). To evaluate the impact of global and domain-specific cognitive impairment on functional recovery and quality of life (QOL) after SAH. One hundred thirteen patients (mean age 49 years; 68% women) were evaluated 3 months after SAH. Three simple tests of global mental status and neuropsychological tests to assess seven specific cognitive domains were administered. Four aspects of outcome (global handicap, disability, emotional status, and QOL) were compared between cognitively impaired and unimpaired patients with analysis-of-covariance models controlling for age, race/ethnicity, and education. Multiple linear regression was used to evaluate the relative contribution of global and domain-specific cognitive status for predicting concurrent modified Rankin Scale (mRS) and Sickness Impact Profile (SIP) scores. Impairment of global mental status on the Telephone Interview of Cognitive Status (TICS) was associated with poor performance in all seven cognitive domains (all p < 0.0005) and was the only cognitive measure associated with poor recovery in all four aspects of outcome (all p < or = 0.005). Cognitive impairment in four specific domains was also associated with functional disability or reduced QOL. After accounting for global cognitive impairment with the TICS, however, neuropsychological testing did not contribute additional predictive value for concurrent mRS or SIP total scores. Cognitive impairment impacts broadly on functional status, emotional health, and QOL after SAH. The TICS may be a useful alternative to more detailed neuropsychological testing for detecting clinically relevant global cognitive impairment after SAH.
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              Intraventricular hemorrhage and hydrocephalus after spontaneous intracerebral hemorrhage: results from the STICH trial.

              Intraventricular hemorrhage (IVH), either independent of or as an extension of intracranial bleed, is thought to carry a grave prognosis. Although the effect of IVH on outcome in patients with subarachnoid hemorrhage has been extensively reviewed in the literature, reports of spontaneous intracerebral hemorrhage (ICH) in similar situations have been infrequent. The association of hydrocephalus in such situations and its influence on outcome is also uncertain. As a sub-analysis of data obtained through the international Surgical Trial in Intracerebral Hemorrhage (STICH), the impact of IVH, with or without the presence of hydrocephalus, on outcome in patients with spontaneous ICH was analyzed. CT scans of randomized patients were examined for IVH and/or hydrocephalus. Other characteristics of hematoma were evaluated to see if they influenced outcome, as defined by the STICH protocol. Favorable outcomes were more frequent when IVH was absent (31.4% vs. 15.1%; p < 0.00001). The presence of hydrocephalus lowered the likelihood of favorable outcome still further to 11.5% (p = 0.031). In patients with IVH, early surgical intervention had a more favorable outcome (17.8%) compared to initial conservative management (12.4%) (p = 0.141). The presence of IVH and hydrocephalus are independent predictors of poor outcome in spontaneous ICH. Early surgery is of some benefit in those with IVH.
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                Author and article information

                Contributors
                wyang19@jhmi.edu
                caoyong@bjtth.org
                Journal
                Chin Neurosurg J
                Chin Neurosurg J
                Chinese Neurosurgical Journal
                BioMed Central (London )
                2095-9370
                2057-4967
                3 June 2024
                3 June 2024
                2024
                : 10
                : 17
                Affiliations
                [1 ]Department of Neurosurgery, Shenzhen Qianhai Shekou Free Trade Zone Hospital, ( https://ror.org/01me2d674) Shenzhen, China
                [2 ]Department of Neurosurgery, The Johns Hopkins Hospital, ( https://ror.org/05cb1k848) 1800 Orleans Street Suite 6007, Baltimore, MD 21287 USA
                [3 ]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, ( https://ror.org/013xs5b60) No.119 South West 4th Ring Road, Beijing, China
                [4 ]Department of Neurosurgery, National Research Center for Rehabilitation Technical Aids, ( https://ror.org/03c6k3q87) Beijing, China
                [5 ]Department of Neurosurgery, Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, ( https://ror.org/03c6k3q87) Beijing, China
                [6 ]GRID grid.454166.4, ISNI 0000 0004 0511 9692, Key Laboratory of Neuro-Functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, ; Beijing, China
                Article
                369
                10.1186/s41016-024-00369-0
                11149196
                38831472
                81aec2bd-2cb9-4024-9835-e18b7e7089fb
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 8 December 2023
                : 21 May 2024
                Funding
                Funded by: Key Laboratory and Engineering Center in the Field of Rehabilitation of the Ministry of Civil Affairs
                Award ID: 2022GKZS0003
                Award ID: 2022GKZS0004
                Award ID: 2022GKZS0005
                Award Recipient :
                Categories
                Review
                Custom metadata
                © Department of Neurosurgery Beijing Tiantan Hospital 2024

                hydrocephalus,intracerebral hemorrhage,intraventricular hemorrhage,management,systematic review

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