• Toshihiro Ogiwara, Yota Suzuki, Takatoshi Hasegawa, Takuya Nakamura, Yu Fujii, Yoshiki Hanaoka, Kiyoshi Ito, Akifumi Yokota, Fumiko Higashiyama, Fusakazu Oya, and Tetsuyoshi Horiuchi.
• Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan. Electronic address: togiwara@shinshu-u.ac.jp.
• World Neurosurg. 2021 Jun 1; 150: e771-e776.

BackgroundSevere intraventricular hemorrhage (IVH) is associated with a high mortality rate and poor functional outcome, even with recent neurosurgical developments. IVH requires emergent surgery to save the patient's life, but the optimal surgical strategy remains controversial. We assessed the results obtained with our tailor-made endoscopic surgical strategy for severe IVH with obstructive hydrocephalus.MethodsConsecutive patients with severe IVH owing to intracerebral hemorrhage who were treated with endoscopic surgery in the acute phase were retrospectively reviewed. Both rigid and flexible endoscopes were used for removal of hematoma in the whole ventricular system. Endoscopic third ventriculostomy and septostomy were performed as appropriate in each individual case.ResultsEight patients met the inclusion criteria and were included in the analysis. Sufficient IVH removal without neglecting the fourth ventricle was achieved with our technique in 6 of 8 cases (75.0%). Endoscopic third ventriculostomy and septostomy were added in 4 cases each (50.0%). Four patients (50.0%) had a marked recovery and a good outcome (modified Rankin Scale score ≤2) despite disease severity at onset. The procedure was completed successfully in all cases, and there were no surgery-related complications.ConclusionsThis study showed that our tailor-made endoscopic surgical strategy for severe IVH with obstructive hydrocephalus may be beneficial.Copyright © 2021 Elsevier Inc. All rights reserved.

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