Free hand aspiration for large periventricular hemorrhage: Case report

BACKGROUND At present, there are several therapeutic options, including craniotomy and stereotactic aspiration, for large intracerebral hemorrhage perforating in to the lateral ventricle. In the cases with Glasgow Coma Scale (GCS) scores under 6 with anisocoria, external ventricular drainage would be the first choice [2-4]. We have also performed anterior ventricular horn puncture in a standard manner. The target was the foramen of Monro, at a depth of 5.5 c m from the inner table of the skull. The point of insertion was located jus t anterior to the coronal suture, approximately 10 cm above the nasion, and 3 cm from the midline [1]. However, we noticed that the insertion of a cat heter into the periventricular hematoma adjacent to the lateral ventricle w as made easier by tilting the catheter 30 degrees laterally as in the first case (Figure 1). METHODS In our method, inclining the catheter by 30 degrees laterally, we used a si licone tube 3.5 mm in internal diameter (Silascon (R) ventricle drainage tu be, Kaneka Medix Corp., Osaka, Japan) and then replaced it with another Sil ascon (R) tube with a 2.5 mm-internal diameter. From January 1999 through D ecember 2000, eleven patients who all had GCS scores under 6 and anisocoria preoperatively were treated by this method. The series included two patien ts who were undergoing hemodialysis because of renal failure, two with blee ding tendency because of liver dysfunction, and one with heart failure. RESULTS The insertion itself caused no complications. Cerebrospinal fluid was drain ed smoothly after removal of hematoma because the hematoma cavity connectin g with the lateral ventricle was opened. Two typical cases using this techn ique are shown (Figures 1 and 2). All patients recovered favorable consciou sness postoperatively compared with the preoperative state but hemiparesis remained. Postsurgical follow up at 3 months revealed the outcomes evaluate d by Glasgow Outcome Scale (GOS) were moderate disability in 5 patients and severe disability in 6 patients. CONCLUSION This direct aspiration and drainage of a large intracerebral hematoma that ruptures into the lateral ventricle is superior to simple ventricular drain age in regard to the removal of the hematoma clot. This technique would be the choice especially in patients with serious complications such as cardia c disease and renal failure. (C) 2001 by Elsevier Science Inc.