Turkish Neurosurgery 2022 , Vol 32 , Num 2
Intraventricular Hematoma Removal with Combined Drainage Techniques in Patients with High-Grade Subarachnoid Hemorrhage: A Surgical Technique
1Ankara University School of Medicine, Department of Neurosurgery, Ankara, Turkey DOI : 10.5137/1019-5149.JTN.34929-21.4 AIM: To describe a surgical technique for removal of hematomas in the third ventricle in patients with high-grade aneurysmal subarachnoid hemorrhage (SAH) and report our intraoperative observations and surgical and clinical outcomes.

MATERIAL and METHODS: Ninety-four patients with high-grade aneurysmal subarachnoid hemorrhagic were included in the study. Prior to Sylvian dissection, a ventricular catheter was inserted as soon as possible. After surgical corridor opening and aneurysm clipping, the lamina terminalis (LT) was fenestrated. The free flow of isotonic solution from the back-side open syringe to the distal end of the catheter inside the third ventricle was allowed under gravitational force. The blood clot trapped in the third ventricle was removed through the aperture of the LT by propulsion of blood through the anterior movement of the solution. The procedure was continued until the clearance of solution was observed.

RESULTS: The study population consisted of two groups, the combined surgical technique group and the control group, which included patients who underwent operation before the planned study, with 47 patients in each group. The Glasgow Coma, Hunt and Hess, and Fisher scales were used to determine the clinical and radiological severities of the cases. The Modified Rankin Scale was used to evaluate the surgical outcomes at presentation and the 6th and 12th postoperative months.

CONCLUSION: Our reported surgical technique, which combines ventricular drainage and opening of the LT, will be useful for removing blood clots and blood breakdown products, and recirculating cerebrospinal fluid as much and as soon as possible in high-grade SAH patients with ventricular hemorrhage. Although combining these two well-known procedures as a novel technique does not have any reducing effect on mortality, it may have a significant reducing effect on hydrocephalus and shunt dependency. Keywords : Intraventricular haematoma, Drainage, Fenestration, Lamina terminalis, Aneurysmal subarachnoid haemorrhage

Corresponding author : Melih BOZKURT, melihbozkurt@hotmail.com