Neurosurgical Intervention in Primary Intraventricular Hemorrhage : Experience from a Center in China

Objective: Primary intraventricular hemorrhage (PIVH) is a rare type of neurologic disorder and remains a challenge for cerebrovascular surgeons. This study intended to investigate the factors associated with neurosurgical intervention and its impact on outcome after PIVH.

Methods: We retrospectively included consecutive patients with PIVH admitted to at a single tertiary academic medical center in China. Conservative treatment or neurosurgical intervention options (including endovascular therapy, craniotomy, stereotactic radiotherapy, endoscopic surgery or external ventricular drain) were assessed. Multivariable logistic regression was applied to determine associations.

Results: In total, 174 patients with PIVH were included in our analysis. There were 79 (45.4%) patients underwent surgery, which was associated with younger age (P = 0.004), higher Baseline Graeb score (P = 0.001), acute hydrocephalus (P = 0.02) and underlying cerebrovascular diseases (P < 0.001) in an adjusted model. In multivariable logistic regression analysis, significant predictors of external ventricular drain after PIVH were higher Baseline Graeb score (P = 0.04), and acute hydrocephalus (P< 0.001). Furthermore, after adjustment for confounders, our analysis showed that neurosurgical intervention could decrease 90-day mortality after PIVH (P = 0.04).

Conclusion: After PIVH, younger patients with higher Baseline Graeb score, acute hydrocephalus and underlying cerebrovascular diseases were more likely to undergo neurosurgical intervention. Surgical treatment of PVIH patients should be optimized to decrease mortality. However, further clinical trials are still needed to determine which patients would benefit from neurosurgical intervention.