Continuous Free External Ventricular Drainage in Hypertensive Intracerebral Hemorrhage with Ventricular Rupture.

Hwang, Sung Nam; Jang, Ji Soo; Kim, Young Beag; Min, Byung Kook; Suk, Jong Sik; Choi, Duck Young; Rhim, Kwang Seh

Original Article

Journal of Korean Neurosurgical Society 1987;16(2): 335-346.

Sung Nam Hwang, Ji Soo Jang, Young Beag Kim, Byung Kook Min, Jong Sik Suk, Duck Young Choi, Kwang Seh Rhim

Department of Neurosurgery, College of Medicine, Choong-Ang University, Korea.

ABSTRACT

There are several methods in the surgical treatment of hypertensive intracerebral hemorrhage, such as craniotomy and hematoma removal, stereotaxic aspiration of hematoma and external ventricular drainage with maintaining physiologic ventricular pressure(over-pressure EVD). In spite of all these methods, surgical treatment yields unsatisfactory results when the patient is comatous and show herniation signs preoperatively. We treated 9 cases of hypertensive intracerebral hemorrhage with ventricular rupture by hematoma removal and continuous free external ventricular drainage instead of over-pressure drainage. In 4 cases, during the drainage, obstruction of the drainage catheter by blood clots or clamping resulted in immediate deterioration of the patient's condition, which was reversed by maintaining the patency suggesting that postoperative control of ICP was essential in treating hypertensive intracerebral hemorrhage in addition to hematoma removal. 7 out of 9 cases regained consciousness and improved gradually with mild to serve neurologic deficit. One patient died of rebleeding in the midbrain and one was discharged by family's will.

Key Words: Hypertension; Intracerebral hemorrhage; Cerebral edema; External venternal drainage; Surgery