Single versus bilateral external ventricular drainage for intraventricular fibrinolysis using urokinase in severe ventricular haemorrhage

Abstract

Background: Intraventricular fibrinolysis (IVF) through bilateral external ventricular drains (EVD) may provide better access of the thrombolytic agent to the intraventricular clot, potentially leading to faster clot clearance.

Objective: To compare the feasibility and safety between single and bilateral EVD groups.

Methods: Patients with spontaneous intraventricular haemorrhage (IVH) (Graeb score ≥ 5) were treated with IVF. The selection for placement of one or two EVDs was randomized. The average daily CSF drainage volume, the indwelling EVD time, the time for monitoring in intensive care unit (ICU), intracranial re-haemorrhage and intracranial infection, Glasgow coma score (GCS), Graeb score and the reserved IVH volume have been analysed for patients with one (group I, n = 22) or two EVDs (group II, n = 25).

Results: Significant difference was found in the average daily CSF drainage volume between the two groups (85.2 (SD = 13.7) vs. 108.5 (15.9) ml). No difference was found in the indwelling EVD time, the time for monitoring in the ICU. Through repeated measurements of the variance analysis, the test for a difference in IVH volume over time was statistically significant (F = 466.981, p = 0.000) and the test for the interaction between treatment and time was also significant (F = 5.033, p = 0.002), indicating that the IVH volume decreased over time in both groups, with a sharper decrease in Group II. Intracranial re-haemorrhage and infection was not found in this study.

Conclusion: The results provide some evidence to support the use of bilateral EVDs for IVF in patients with severe IVH.

• External ventricular drainage (EVD)
• Intraventricular haemorrhage (IVH)
• Intraventricular fibrinolysis (IVF)