Analysis of Combined Coiling and Neuroendoscopy in the Treatment of Intraventricular Hemorrhage Due to Ruptured Aneurysm

Abstract

Background: Subarachnoid hemorrhage (SAH) with intraventricular hemorrhage (IVH) is associated with poor outcomes. The aim of this study was to evaluate the effectiveness of combined coiling and neuroendoscopy to treat severe SAH with massive IVH. Method: Between April 2008 and March 2012, 13 patients had massive IVH with a ruptured aneurysm treated at the Department of Neurosurgery, Fukuoka University, Japan. All 13 patients were treated within 2 days of onset by coiling and neuroendoscopic removal of the IVH, including the fourth ventricle. Results: No rebleeding or acute hydrocephalus were noted. Glasgow Outcome Scale scores (GOS) at discharge were: good recovery (two patients), moderate disability (three patients), severe disease (one patient), vegetative state (four patients), and dead (three patients). A good modified Rankin Scale score (mRS) (0-2) at 6 months was observed in six patients and a poor mRS score (3-6) occurred in seven. The pre- and post-operative Graeb scores were significantly lower in the good mRS group (p = 0.020 and 0.033, respectively, Mann-Whitney U-test). GOS scores at discharge were significantly associated with mRS score at 6 months (p = 0.011, Fisher's Exact Test). Conclusions: Combined coiling and neuroendoscopic removal of the IVH, including the fourth ventricle, were feasible procedures and achieved preferable outcomes in approximately half of the cases.