Modified ventricular puncture combined with urokinase in the treatment of secondary intraventricular cast hemorrhage

Background: We introduce a new catheter-based minimally invasive approach via frontal tuber for removing hypertensive intraventricular hemorrhage(IVH), and further compare its treatment efficacy with conventional external ventricular drainage (EVD). Methods: This study is prospective and randomized. Sixty cases of secondary intraventricular cast hemorrhage patients were randomly divided into two groups of 30 cases: modified ventricular puncture (MVP) group and control group. Preoperative Glasgow coma scale (GCS) and Graeb score were compared between the two groups. The postoperative manifestations of two groups were also analyzed and compared statistically, including evacuation rate of intraventricular hematoma in 24 h, the time with drainage tube, rebleeding, complicated by infection, shunt-dependent hydrocephalus and Glasgow outcome scale at 3 months. Results: 1. There was no significant difference in preoperative GCS score and the Graeb score between two groups (P > 0.05). 2. In the MVP group via frontal tuber approach, a substantial removal of intraventricular hematoma was achieved in all cases. The average evacuation rate of intraventricular hematoma reached 80.10 ± 10.16 %, the average time of catheter drainage was 3.17 ± 0.87 days, the average GOS was 3.80 ± 0.92, no intracranial infection and secondary hemorrhage were observed following surgery in all cases, and shunt-dependent hydrocephalus occurred in 2 cases. In the control group, the hematoma evacuation rate was an average of 21.21 ± 7.81 %, the time of drainage was an average of 7.63 ± 2.87 days, the GOS was an average of 3.20 ± 1.12, intracranial infection after surgery occurred in 5 cases, secondary hemorrhage was observed in 1 case, and shunt-dependent hydrocephalus occurred in 8 cases. Between the two groups there were significantly statistical difference in the hematoma evacuation rate, drainage duration, infection rate and GOS (all P < 0.05). Conclusions: The new approach is safe, and can quickly remove the hematoma, and significantly shorten the time with a pipe. It can also reduce the occurrence of infection and hydrocephalus, and improve overall outcome of patients, but cannot reduce mortality.