The intra-neuroendoscopic technique: A new method for rapid removal of acute severe intraventricular hematoma

Bo Du, Ai-Jun Shan, Yu-Juan Zhang, Jin Wang, Kai-Wen Peng, Xian-Liang Zhong, Yu-Ping Peng, Bo Du, Ai-Jun Shan, Yu-Juan Zhang, Jin Wang, Kai-Wen Peng, Xian-Liang Zhong, Yu-Ping Peng

Abstract

The mortality rate of acute severe intraventricular hematoma is extremely high, and the rate of disability in survivors is high. Intraventricular hematoma has always been a difficult problem for clinical treatment. Although minimally invasive endoscopic hematoma evacuation is widely used to treat this disease, the technique still has room for improvement. Equipment for the intra-neuroendoscopic technique (INET) consists of two of our patented inventions: a transparent sheath (Patent No. ZL 200820046232.0) and a hematoma aspirator (Patent No. ZL 201520248717.8). This study explored the safety and efficacy of INET by comparing it with extraventricular drainage in combination with urokinase thrombolytic therapy. This trial recruited 65 patients with severe intraventricular hemorrhage, including 35 (19 men and 16 women, aged 53.2 ± 8.7 years) in the INET group and 30 (17 men and 13 women, aged 51.5 ± 7.9 years) in the control group (extraventricular drainage plus urokinase thrombolytic therapy). Our results showed that compared with the control group, the INET group exhibited lower intraventricular hemorrhage volumes, shorter intensive care-unit monitoring and ventricular drainage-tube placement times, and fewer incidences of intracranial infection, secondary bleeding, and mortality. Thus, the prognosis of survivors had improved remarkably. These findings indicate that INET is a safe and efficient new method for treating severe intraventricular hematoma. This trial was registered with ClinicalTrials.gov (NCT02515903).

Keywords: extraventricular drainage; intra-neuroendoscopic technique; minimally invasive surgery; nerve regeneration; neural regeneration; prognosis; transparent sheath; urokinase thrombolysis; ventricular hemorrhage.

Conflict of interest statement

The authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper

Figures

Figure 1
Figure 1
Flow chart of the study. IVH: Intraventricular hemorrhage; INET: intra-neuroendoscopic technique; ICU: intensive care unit; VDT: ventricular drainage tube; PDTO: postoperative drainage tube obstruction; GCS: Glasgow Coma Scale; GOS: Glasgow Outcome Scale.
Figure 2
Figure 2
Transparent sheath and neuroendoscope before (upper) and after (lower) assembly.
Figure 3
Figure 3
A 3-cm-base small curved flap. Arrow: The drainage tube.
Figure 4
Figure 4
Surgical process for removing a ventricular hematoma. (A) A hematoma in the lateral ventricle was clearly visible after endoscope implantation. Arrow: Edge of the transparent sheath. (B) Removal of a hematoma in the lateral ventricle body. Arrow: Head of the suction tube. (C) Removal of a hematoma in the occipital horn. (D) Removal of a hematoma in the third ventricle through the foramen of Monro. Arrow: Hematoma. (E) The choroid plexus and superior choroid vein were clearly visible after removal of a lateral ventricle hematoma. Black arrow: Choroid plexus; white arrow: superior choroid vein. (F) The bottom of the third ventricle was clearly visible after removal of the hematoma. Arrow: Bottom structure of the third ventricle.
Figure 5
Figure 5
CT images before and after surgery. A left thalamus hematoma had broken into the ventricle. (A) Before the operation. (B) Immediately after the operation. (C) CT scan 3 days after the operation.

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