Acta Neurochirurgica

, Volume 122, Issue 1–2, pp 23–31 | Cite as

Intraventricular haemorrhage caused by aneurysms and angiomas

  • E. Donauer
  • J. Reif
  • B. Al-Khalaf
  • E. F. Mengedoht
  • C. Faubert
Clinical Articles

Summary

More than 200 intraventricular haematomas (IVH) have been treated in the Homburg Neurosurgical University Clinic since computed tomography was available and facilitated the diagnosis.

Among 200 consecutive cases, which are analysed and presented in this publication, there were 71 patients with subarachnoid haemorrhage (SAH)-58 of whom with angiographically and/or pathologically verified aneurysms-, and 21 cases with intraventricular angiomas. IVH without concomitant intracerebral haematoma (ICH) and without evidence of SAH is highly suggestive of intraventricular angioma.

In our experience panangiography [if available digital subtraction angiography (DAS)] should be done as soon as possible in all cases of IVH. It is a precondition for early diagnosis and operative elimination of the source of bleeding, because the retrospective analysis of our material shows that rebleeding is by far the highest single risk factor in cases with IVH caused by aneurysms or angiomas.

We therefore recommend early microsurgical occlusion of the aneurysms and exstirpation or intravascular embolisation of the angioma.

The best survival rate (76%) was achieved in IVH cases caused by angiomas. In aneurysms with IVH the survival rate was 35%, in IVH caused by other diseases 37%. The worst prognosis occurs in SAH with IVH without proven aneurysm or angioma. The survival rate of this group was only 8%.

Keywords

Intraventricular haemorrhage aneurysm angioma hydrocephalus management results 

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References

  1. 1.
    Bailes JE, Spetzler RF, Hadley MN, Baldwin HZ (1990) Management morbidity and mortality of poor-grade aneurysm patients. J Neurosurg 72: 559–566Google Scholar
  2. 2.
    Donauer E, Faubert C (1991) Management of intracerebral haematomas. In: Kaufmann HH (ed) Intracerebral haematomas. Raven, New York, pp 211–227Google Scholar
  3. 3.
    Donauer E, Kivelitz R, Jaksche H, Schmid C, Loew F (1988) Ventrikelblutungen: Therapie und Prognose. Nervenarzt 59: 636–639Google Scholar
  4. 4.
    Drake CG (1979) Cerebral arteriovenous malformations: considerations for and experience with surgical treatment in 166 cases. Clin Neurosurg 26: 145–208Google Scholar
  5. 5.
    Eskesen V, Rosenorn J, Schmidt K (1988) The impact of rebleeding on the life time probabilities of different outcomes in patients with ruptured intracranial aneurysms. Acta Neurochir (Wien) 95: 99–101Google Scholar
  6. 6.
    Freckmann N, Noll M, Winkler D, Nowak G, Rehn H, Neuss M, Herrmann HD (1987) Does the timing of aneurysm surgery neglect the real problems of subarachnoid haemorrhage? Acta Neurochir (Wien) 89: 91–99Google Scholar
  7. 7.
    Graeb DA, Robertson WD, Lapointe JS (1982) Computed tomography diagnosis of intraventricular haemorrhage. Radiology 143: 91–96Google Scholar
  8. 8.
    Ikeda Y, Nakazawa S, Higuchi H (1982) Clinical aspects and prognosis of intraventricular haemorrhage with cerebrovascular disease-CT findings and etiological analysis. J Neurol Med Chir 22: 822–828Google Scholar
  9. 9.
    Heros RC, Korosue K, Diebold PM (1990) Surgical excision of cerebral arteriovenous malformations: late results. Neurosurgery 26: 570–578Google Scholar
  10. 10.
    Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28: 14–20Google Scholar
  11. 11.
    Hunt WE, Kassel N, Pertuiset B, Sano K, Teasdale G, de Villier JC, Drake CG (1988) Report of the World Federation of Neurological Surgeons committee on an universal subarachnoid haemorrhage grading scale. J Neurosurg 68: 985–986Google Scholar
  12. 12.
    Loew FD, Jaksche H (1980) IVH surgical treatment: Possibilities of operative treatment and its limitations. In: Pia HWet al (eds) Spontaneous intracerebral haematomas. Springer, Berlin Heidelberg New York, pp 281–283Google Scholar
  13. 13.
    Little JR, Blomqvist GA, Ethier R (1977) Intraventricular haemorrhage in adults. Surg Neurol 8: 143–147Google Scholar
  14. 14.
    Pia HW (1972) The surgical treatment of intracerebral and intraventricular haematomas. Acta Neurochir (Wien) 27: 149–164Google Scholar
  15. 15.
    Reif J (1992) Hirnnervenläsionen nach operativer versorgung von aneurysmen des vertebrobasilären Kreislaufes. Verhandlungsband der Deutschen Gesellschaft für Neurologie. 65. Jahrestagung (in press)Google Scholar
  16. 16.
    Ruscadella J, Peiro A (1986) Prognostic factors in intraparenchymatous haematoma with ventricular haemorrhage. Neuroradiology 28: 34–37Google Scholar
  17. 17.
    Sands IL, Lederer M (1927) Intraventricular haemorrhage. J Nerv Ment Dis 65: 360–371Google Scholar
  18. 18.
    Spetzler RF, Martin NA (1986) A proposed grading system for arteriovenous malformations. J Neurosurg 65: 476–483Google Scholar
  19. 19.
    Steudel WI, Schneider E, Becker H (1980) IVH: CT scan and treatment. In: Pia HWet al (eds) Spontaneous intracerebral haematomas. Springer, Berlin Heidelberg New York, pp 331–334Google Scholar
  20. 20.
    Todo T, Usui M, Takakura K (1991) Treatment of severe intraventricular haemorrhage by intraventricular infusion of urokinase. J Neurosurg 74: 81–86Google Scholar
  21. 21.
    U HS (1985) Microsurgical excision of paraventricular arteriovenous malformations. Neurosurgery 16: 293–303Google Scholar
  22. 22.
    Waga S, Shimosaka S, Kojima T (1985) Arteriovenous malformations of the lateral ventricle. J Neurosurg 63: 185–192Google Scholar
  23. 23.
    Yaşargil MG (1984) Microneurosurgery, Vol 1. Thieme, StuttgartGoogle Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • E. Donauer
    • 2
  • J. Reif
    • 2
  • B. Al-Khalaf
    • 2
  • E. F. Mengedoht
    • 2
  • C. Faubert
    • 2
    • 1
  1. 1.Department of Neuroradiology of the Saarland UniversityHomburg/SaarGermany
  2. 2.Departments of Neurosurgery of the Saarland UniversityHomburg/SaarGermany

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