Neurosurgical Review

, Volume 35, Issue 4, pp 485–495 | Cite as

Management of non-traumatic intraventricular hemorrhage

  • Thomas GaberelEmail author
  • Christian Magheru
  • Evelyne Emery


Intraventricular hemorrhage (IVH) is defined as the eruption of blood in the cerebral ventricular system and is mostly secondary to spontaneous intracerebral hemorrhage and aneurysmal and arteriovenous malformation rupture. IVH is a proven risk factor of increased mortality and poor functional outcome. Its seriousness is correlated not only with the amount of blood but also with the involvement of the third and fourth ventricles. There are four mechanisms that explain the pathophysiology of this event: acute obstructive hydrocephalus, the mass effect exerted by the blood clot, the toxicity of blood-breaking products on the adjacent brain parenchyma, and, lastly, the development of a chronic hydrocephalus. It is thus obvious that the clearance of blood from the ventricles should be a therapeutic goal. In cases of acute hydrocephalus, external ventricular drainage is a mandatory step, but proven often insufficient. The concomitant use of intraventricular fibrinolytics such as recombinant tissue plasminogen activator or urokinase seems to be beneficial at least in the context of spontaneous intracerebral hemorrhage, in which their use is now accepted but not yet validated by a randomized trial. Given the potential neurotoxicity of these agents, further research is needed in order to identify the best treatment for intraventricular fibrinolysis (IVF). The endoscopic retrieval of intraventricular blood was also described recently and seems to be as efficient as IVF, but its use is limited to specialized centers. IVH represents a therapeutic challenge for neurosurgeons, neurologists, and intensivists. Thus, a better understanding of this dramatic event will help in better tailoring the treatment strategies.


Intraventricular Cerebral hemorrhage Fibrinolytic agents Ventriculostomy Neuroendoscopy 



The authors thank Miss Apollonia Annang for her assistance in English corrections and Keven Ponte for his computing assistance.

Sources of funding


Conflicts of interest/disclosures

The authors declare that they have no conflict of interest or financial disclosure.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Thomas Gaberel
    • 1
    • 2
    Email author
  • Christian Magheru
    • 1
  • Evelyne Emery
    • 1
    • 2
  1. 1.Department of NeurosurgeryCaen University HospitalCaenFrance
  2. 2.INSERM, U919, Sérine Protease and Pathophysiology of the Neurovascular Unit, SP2U, UMR CNRS 6232, Centre d’Imagerie et de Neurosciences Appliquées aux Pathologies GIP CyceronUniversity Caen Lower NormandyCaenFrance

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