Comparative Study between Conservative and Surgical Management of Intraventricular Hemorrhage

Document Type : Original Article


The Department of Neurosurgery, Faculty of Medicine, Beni-Suef* and Cairo** Universities


Abstract Background: Intraventricular (IVH) occurs frequently in concurrence with intracranial (ICH) and subarachnoid hem-orrhage (SAH). IVH can vary between a mild trace to complete filling of all ventricles. External ventricular drainage (EVD) is the treatment of choice for symptomatic hydrocephalus associated with IVH and may help in clearance of blood. It is controversial in the setting of poor GCS or fair GCS (more than 10). Aim of Study: This study focuses on the management of IVH in patients with fair GCS (>10). Conservative treatment is assessed as a possible alternative in the management of IVH. Patients and Methods: Retrospective analysis was per-formed for adult patients with intraventricular hemorrhage in Kasr El-Aini and Beni-Suef University Hospitals during the period between February 2019 and February 2021 who were managed either conservatively or surgical. The study included patients with GCS more than 10. Good outcome was defined when GCS improved at discharge 2 points or more. Results: This study included 78 patients. They were divided into two groups; group A Conservative management and group B Surgical management by EVD. Group A included 40 patients. The Graeb score was mild (1-4) in 10 (25%) patients, moderate (5-8) in 22 patients (55%) patients, and severe (9-12) in 8 (20%) patients. There was associated ICH in 23 (58%) patients, and no ICH in 17 (43%) patients. The outcome was good in 36 (90%) cases and 4 (10%) cases died. Group B included 38 cases. The Graeb score was mild (1-4) in 5 patients (13%) in, moderate (9-12) in 20 (53%), and severe (9-12) in 13 patients (34 %). Secondary intraventricular hemorrhage was found in 32 (84%) of cases & primary intraventricular hemorrhage (without intracerebral hemorrhage) in 8 (21%). The outcome was good in 23 cases (61%) and 15 cases (39%) died. CSF infection occurred in 10 patients (26%). Conclusion: Conservative management of IVH appears to have a better outcome in comparison with external drainage in patients with fair GCS (>10) and it can prevent unwanted complications of EVD such as CSF infection.