[Analysis of the efficacy and prognosis of neuroendoscopic ventricular hematoma evacuation in the treatment of ventricular cast hemorrhage in high-altitude areas].

Objective: To explore the effect and prognosis of neuroendoscopic intraventricular hematoma evacuation for ventricular cast hemorrhage (VCH) in high-altitude regions. Methods: A total of 66 VCH patients who underwent surgical treatment at Changdu Municipal People's Hospital between September 2023 and December 2024 were enrolled and divided into two groups based on the surgical procedure: the high-altitude endoscopy group and the high-altitude drainage group. Additionally, 29 VCH patients who underwent surgical treatment at the First Affiliated Hospital of Chongqing Medical University between September 2022 and December 2024 were included as the plain drainage group. The operation duration, hematoma clearance rate, complication rate, duration of drainage catheter indwelling, hospital stay, Glasgow Coma Scale (GCS) score at 15 days postoperatively, and Glasgow Outcome Scale (GOS) score at 3 months postoperatively were compared respectively between the high-altitude endoscopy group and the high-altitude drainage group, as well as between the high-altitude drainage group and the plain drainage group to evaluate the therapeutic effect and prognosis. Results: A total of 95 VCH patients (62 males and 33 females)with an age of [M(Q1, Q3)] 55 (51, 58) years, comprising 36 cases in the high-altitude endoscopy group, 30 cases in the high-altitude drainage group, and 29 cases in the plain drainage group. No statistically significant differences were observed among the three groups in terms of gender, age, volume of hemorrhage, or GCS score on admission (all P>0.05).The hematoma clearance rates in the high-altitude drainage group on postoperative days 1, 3, and 7 were 47% (46%, 50%), 61% (56%, 71%), and 72% (68%, 75%), respectively, which were lower than those in the plain drainage group [56% (53%, 58%), 71% (62%, 76%), and 78% (75%, 82%), respectively], and the incidence of various complications was also higher than that in the plain drainage group. The catheter indwelling duration 7 (7, 8) days and hospital stay (23.3±3.4) days in the high-altitude drainage group were higher than those in the plain drainage group, which were 5(5, 6) days and (19.0±4.7) days . Furthermore, the high-altitude drainage group had lower GOS score a at 3 months after operation [3.5 (2.8, 4.0)], compared to that in the plain drainage group [4.0 (3.0, 5.0)] (all P<0.025).In comparison with the high-altitude drainage group, the high-altitude endoscopy group demonstrated higher hematoma clearance rates [82% (80%, 85%), 87% (84%, 89%), and 93% (92%, 96%)] on days 1, 3, and 7, respectively(all P<0.025) .Compared with the high-altitude drainage group, patients in the high-altitude endoscopy group had reduced complication rate, shorter hospital stay[(20.2±4.8) d], and higher GOS scores at 3 months[4.0(4.0, 5.0)] postoperatively (all P<0.025). Conclusions: External ventricular drainage alone yields suboptimal outcomes for VCH patients in high-altitude regions compared to those in plain areas. Neuroendoscopic hematoma evacuation in high-altitude areas can reduce postoperative complications and improve short-term prognosis compared to external ventricular drainage.