Risk factor analysis of long-term outcomes in patients with large intracerebral and intraventricular hemorrhage treated primarily with combined external ventricular drainage and intraventricular thrombolysis.

PURPOSE: Surgical outcomes are typically poor for patients with spontaneous large intracerebral hemorrhage (ICH) complicated by intraventricular hemorrhage (IVH). The optimal treatment strategy remained undetermined -either external ventricular drainage (EVD) alone or in combination with craniotomy. Here, we evaluated shunt-related complications of such patients treated primarily with EVD combined with intraventricular thrombolysis, aiming to provide evidence that may lead to future treatment guidelines.

MATERIALS AND

METHODS

From January 2010 to December 2021, a total of 114 patients with spontaneous large ICH (> 30 mL) extending into the ventricular system treated only primarily with EVD and intraventricular thrombolysis were retrospectively enrolled. Hematoma and ventricular volumes were assessed based on imaging data. Cerebrospinal fluid (CSF) parameters-including biochemistry and cell counts-were analyzed in relation to permanent shunt dependency and one-year mortality.

RESULTS

The mean age of the patients was 67.6 ± 11 years, with a male-to-female ratio of 1.7:1. Their mean best Glasgow Coma Scale (GCS) motor score was 3.7 ± 1.9. Mean ICH/IVH volume was 70.9 ± 47 mL. Average daily CSF drainage was 104 ± 52.2 mL, with a mean drainage duration of 16.5 ± 9.4 days. The average number of EVD replacements was 1.9 ± 0.8. WBC/RBC counts(/mm3) in CSF were 110.4 ± 250.3/28997.8 ± 104,400.2 at the first EVD procedure and 5.4 ± 9.0/532 ± 761.9 at the last procedure. Multivariate analysis identified the narrower width of the temporal horn (p < 0.01) and CSF lymphocyte count at the initial EVD procedure (p < 0.05) as independent risk factors for needing a permanent shunt. One-year mortality was significantly associated with pupil size (p < 0.01), daily CSF drainage volume (p < 0.05), and presence of periventricular lucency (p < 0.05). The primary predictor of central nervous system (CNS) infection was CSF WBC count at the final EVD procedure (p < 0.05).

CONCLUSION

The prolonged and repeated use of external ventricular drainage (EVD) in patients with large intracerebral hemorrhage (ICH) complicated by intraventricular hemorrhage (IVH) appears to be a practical and recognizable treatment approach. Early identification of imaging and CSF markers would likely help optimize management strategy for this high-risk population.