1. General data: clinical data of 693 patients with HICH admitted to our hospital from January 2010 to September 2020 were collected. According to the inclusion and exclusion criteria, 87 patients were included in our study. 58 cases were male and 29 cases were female, their ages ranged from 34 to 71 years, with a mean age: 53. 2 ± 4.6 years, 31 cases with TH and 56 cases with hematoma breaking into the ventricles.
2. Inclusion criteria: (1) patients with clinical diagnosis of TH and underwent EVD, (2) patients with failed EVD clamping and underwent VPS or ETV, (3) patients with complete records of clinical and imaging data before and after surgery.
3. Exclusion criteria: (1) patients with brain herniation at admission and in a near-death state, (2) bleeding caused by organic pathologiessuch as arteriovenous malformations, Moyamoya disease, cerebral aneurysms, or traumatic events. (3) patients with preoperative coagulation disorders or hematologic disorders, (4) patients with severe mental illness, (5) patients with incomplete clinical information.
4. Criteria for failure to clamp EVD tube: (1) CT showed ventricular dilatation, (2) Increased ICP or hydrocephalus symptoms such as drowsiness, headache, nausea and vomiting.
5. The operation mode was as follows:
All patients were evaluated by CT at admission. If TH﹥30ml, puncture and aspiration of hematoma was performed, when slight negative pressure occurred, the suction was stopped and an external drainage tube was placed. If TH broke into the ventricle or acute obstructive hydrocephalus was seen on CT, so it was treated with EVD, CT was checked within 24 hours after operation. The remaining hematoma were liquefied and drained by EVD combined with urokinase. After the intraventricular hematoma is disappear and two weeks after EVD, attempt to clip the EVD tube and consider CSF diversion if EVD drain clamping fails.
ETV group:
All patients were treated with endotracheal intubation and general anesthesia. Through the right frontal horn - lateral ventricle - interventricular foramen - third ventricle, puncture the lateral ventricle with endoscopic puncture sheath, place endoscope into the sheath to explore the ventricle, and perform the ETV. The site of fistula was the weakest in the triangular area in front of bilateral papillae. First, the small hole was formed by bipolar electrocoagulation, then the dilated balloon catheter was placed into the hole, the fistula was expanded to 4-5mm, the fistula was washed with 37 ℃ balance liquid, the water flow was observed, and it was confirmed that the fistula was unobstructed and fully communicated with the interpeduncular pool.
VPS group:
All patients were treated with endotracheal intubation and general anesthesia. Medtronic adjustable pressure drainage kit is adopted. Puncture the triangular area of the right lateral ventricle, place the ventricular end of the shunt tube, connect the pressure regulating valve, and place the pressure regulating valve slightly above the back of the ear through the subcutaneous tunnel. Above the right side of the navel, open the abdominal cavity through the paramedian incision, and lead the abdominal end of the shunt tube to the abdomen through the subcutaneous tunnel. After confirming that the drainage tube is unobstructed, put the abdominal end of the shunt tube into the abdominal cavity and fix it.
All patients were routinely monitored for vital signs, bed head elevation of 30°, rehydration, infection prevention and other treatments after surgery.
5. Postoperative Evaluation
All patients underwent CT examination within 24 hours of surgery to assess postoperative intracranial conditions. Postoperative observation indicators included operation time, hospitalization days, postoperative complications. A clinical success of surgery was assumed when the patient was followed alive and without subsequence hydrocephalus procedures like shunting. All patients were followed up for 1 year.
6. This study was approved by the Medical Ethical Committee of Xi’an Daxing Hospital. Written informed consent was obtained from all patients.
7. Statistical analysis: Data were analyzed using statistical product and service solutions software version 22.0. Continuous variables were expressed as mean±standard deviation or median. Differences between variables were evaluated using the independent samples t-test. Categorical variables were expressed as a ratio (%), and differences between variables were compared using the chi-squared test. Data were deemed significant if P < 0.05 for all tests.