Drainage Efficiency with Dual Versus Single Catheters in Severe Intraventricular Hemorrhage
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Little is known about the efficacy of single versus dual extraventricular drain (EVD) use in intraventricular hemorrhage (IVH), with and without thrombolytic therapy.
Post-hoc analysis of seven patients with dual bilateral EVDs from two multicenter trials involving 100 patients with IVH, and spontaneous intracerebral hemorrhage (ICH) volume <30 ml requiring emergency external ventricular drainage. Seven “control” patients with single catheters were matched by IVH volume and distribution and treatment assignment. Head CT scans were obtained daily during intraventricular injections for quantitative determination of IVH volume.
Median [min–max] age of the 14 subjects was 56 [40–73] years. Median duration of EVD was 7.9 days (single catheter group) versus 12.2 days (dual catheter group) (P = 0.34). Baseline median IVH volume was not significantly different between groups (75.4 ml [22.4–105.1]—single EVD vs. 84.5 ml [42.0–132.0]—dual EVD; P = 0.28). Comparing the change in IVH volume on time-matched CT scans during dual EVD use, the median decrease in IVH volume in dual catheter patients was significantly larger (52.1 [31.7–81.1] ml) versus single catheter patients (34.5 [13.1–73.9] ml) (P = 0.004). There was a trend to greater decrease in IVH volume during dual EVD use in both rt-PA (P = 0.9) and placebo-treated (P = 0.11) subgroups.
The decision to place dual EVDs is generally reserved for large IVH (>40 ml) with casting and mass effect. The use of dual simultaneous catheters may increase clot resolution with or without adjunctive thrombolytic therapy.
- Vereecken, KK, Havenbergh, T, Beuckelaar, W, Parizel, PM, Jorens, PG (2006) Treatment of intraventricular hemorrhage with intraventricular administration of recombinant tissue plasminogen activator. A clinical study of 18 cases. Clin Neurol Neurosurg 108: pp. 451-455 CrossRef
- Coplin, WM, Vinas, FC, Agris, JM (1998) A cohort study of the safety and feasibility of intraventricular urokinase for nonaneurysmal spontaneous intraventricular hemorrhage. Stroke 29: pp. 1573-1579 CrossRef
- Findlay, JM, Grace, MG, Weir, BK (1993) Treatment of intraventricular hemorrhage with tissue plasminogen activator. Neurosurgery 32: pp. 941-947 CrossRef
- Andrews, CO, Engelhard, HH (2001) Fibrinolytic therapy in intraventricular hemorrhage. Ann Pharmacother 35: pp. 1435-1448 CrossRef
- Naff, NJ, Carhuapoma, JR, Williams, MA (2000) Treatment of intraventricular hemorrhage with urokinase : effects on 30-Day survival. Stroke 31: pp. 841-847 CrossRef
- Staykov, D, Huttner, HB, Lunkenheimer, J (2010) Single versus bilateral external ventricular drainage for intraventricular fibrinolysis in severe ventricular haemorrhage. J Neurol Neurosurg Psychiatry 81: pp. 105-108 CrossRef
- Kothari, RU, Brott, T, Broderick, JP (1996) The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27: pp. 1304-1305 CrossRef
- Graeb, DA, Robertson, WD, Lapointe, JS, Nugent, RA, Harrison, PB (1982) Computed tomographic diagnosis of intraventricular hemorrhage. Etiology and prognosis. Radiology 143: pp. 91-96
- Pang, D, Sclabassi, RJ, Horton, JA (1986) Lysis of intraventricular blood clot with urokinase in a canine model: Part 1. Canine intraventricular blood cast model. Neurosurgery 19: pp. 540-546 CrossRef
- Mayfrank, L, Kissler, J, Raoofi, R (1997) Ventricular dilatation in experimental intraventricular hemorrhage in pigs. Characterization of cerebrospinal fluid dynamics and the effects of fibrinolytic treatment. Stroke 28: pp. 141-148 CrossRef
- Drainage Efficiency with Dual Versus Single Catheters in Severe Intraventricular Hemorrhage
Volume 16, Issue 3 , pp 399-405
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- External ventricular drain
- Intraventricular hemorrhage
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- 1. Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Meyer 8-140, 600 N. Wolfe St., Baltimore, MD, USA
- 2. Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- 3. Section of Neurosurgery, University of Chicago Medical Center, Chicago, IL, USA