of Combined Coiling and Neuroendoscopy in the Treatment of Intraventricular Hemorrhage Due to Ruptured Aneurysm

Fig. 1

A representative case. (a, b) CT performed on admission showing an SAH and massive IVH. (c) An internal carotid artery aneurysm is shown on angiography just before coiling (anterior-posterior view). (d, e) CT after successful removal of the IVH. (f) Angiographic appearance of the anterior communicating artery aneurysm after coiling (anterior-posterior view)

There were six patients in the better mRS (0–2) group and seven patients in the worse mRS (3–6) group. Table 1 shows the characteristics of our cases. There was no significant difference in terms of age, gender, WFNS clinical grade, coiling first procedure or endoscopy first procedure, or the follow-up period between the two groups.

Table 1

Patient characteristics

Modified Rankin scale	0–2	3–6	p
Number	6	7
Age (years)	60.7 ± 5.7	65.0 ± 6.1	NS^a
Men:Women	3:3	3:4	NS^b
WFNS Grade IV	1	0
WFNS Grade V	5	6	NS^b
Coil to endoscope	4	2
Endoscope to coil	2	5	NS^b
Preoperative Graeb score	10.3 ± 2.3	10.7 ± 1.5	0.020^c
Postperative Graeb score	4.0 ± 2.3	5.3 ± 4.5	0.033^c
GOS at discharge
GR	2	0
MD	3	0
SD	1	0
VS	0	4
D	0	3	0.011^b
Follow-up period (months)	16.8 ± 9.1	15.3 ± 8.6	NS^a

WFNS World Federation of Neurological Surgeons, GOS Glasgow outcome scale, GR good recovery, MD moderately disabled, SD severely disabled,;VS vegetative state, D dead, NS not significant

^a t-test

^bFischer’s exact test

^c U-test

GOS scores at discharge were significantly associated with mRS score at 6 months (p = 0.011, Fischer’s exact test).

After neuroendoscopic removal of the IVH, a significant reduction in the Graeb score (from 10.7 to 4.9) was observed (p < 0.001, Wilcoxon paired t-test). Comparison of the better mRS group and the worse mRS group showed significant differences in the pre- and post-operative Graeb scores (p = 0.020 and 0.033, respectively, Mann-Whitney U-test).

Discussion

Our study showed that neuroendoscopic removal of the IVH from the lateral to the fourth ventricle combined with coiling of the ruptured aneurysms was feasible, and could produce good outcomes in certain patients with severe SAH and massive IVH. Both the pre- and post-operative Graeb scores were significantly different between the better and the worse mRS groups, suggesting that increasing intracranial pressure was detrimental. This result may justify the endoscopic removal of clots in the fourth ventricle.

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