gms | German Medical Science

Objective: Intracranial hemorrhage following placement of a ventricular tube (VT) often presents in a rather unspecific manner and therefore remains hard to recognize. If early surgical intervention is considered, it may potentially influence and amend further therapeutic strategies and outcome. In this retrospective analysis, we present our experience in 105 consecutive patients with VT after SAH.

Methods: We reviewed the records of 105 consecutive patients with aneurysmal SAH and initial VT that had been admitted to our neurosurgical department during a 2-year period. The aneurysm was treated by operation or by neuroradiological intervention. A CT scan was routinely performed 24 hours after treatment, when neurological symptoms appeared or when neuromonitoring indicated increasing intracranial pressure. All CT scans were analyzed for any new VT-related hemorrhage. We analyzed age, sex, localisation of aneurysm, initial scores (Hunt and Hess, Glasgow Coma Scale, Fisher Grading), post-treatment events such as vasospasm, infarction or aneurysm-related rebleeding and Glasgow Outcome Scale at the time of discharge.

Results: 11 patients (7 male, 4 female, mean age 54.1 years) suffered from postoperative hemorrhage after burr-hole trepanation and VT placement. 9 patients were found to have localized intraparenchymal hemorrhage surrounding the VT, 1 patient had massive intraventricular bleeding and 1 patient had a fulminant generalized intraparenchymal and subarachnoid hemorrhage. Localisation of aneurysm : 5 ICA, 2 MCA, 2 Acomm ant, 1 BA, 1 PCA, 1 no aneurysm found. All patients were scored according to the Hunt&Hess (HH) classification at the time of admission : HH V 5 patients, HH IV 3 patients, HH III 2 patients and HH II 1 patient. Fisher grading was performed referring to the initial CT Scan: IV 5 patients, III 4 patients, II 2 patients. Symptomatic vasospasm occurred in 4 patients leading to cerebral infarction in 3 patients. 5 patients died, 5 patients had an unfavourable outcome according to the Glasgow Outcome Scale (GOS II and III), just 1 patient had a favourable outcome (GOS IV).

Conclusions: In this retrospective study, we found the VT-related hemorrhage rate to be nearly 10%. To our knowledge, this is the first report focussing on a homogenous population. Fisher grading III and IV and Hunt%Hess score IV and V can be interpreted as negative predictors for a higher incidence of complicating rebleeding. Almost all patients with VT-related hemorrhage had an unfavourable outcome according to GOS. These findings outline the importance of the VT-related hemorrhage as a severe complication.