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Acta Neurochirurgica

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01-03-2018 | Original Article - Vascular

Increased rate of ventriculostomy-related hemorrhage following endovascular treatment of ruptured aneurysms compared to clipping

Authors: Christian Scheller, Christian Strauss, Julian Prell, Sebastian Simmermacher, Silvio Brandt

Published in: Acta Neurochirurgica | Issue 3/2018

Abstract

Objective

Acutely ruptured aneurysms can be treated by endovascular intervention or via surgery (clipping). After endovascular treatment, the risk of thromboembolic complications is reduced by the use of anticoagulative agents, which is not required after clipping. The aim of the study is to investigate the rate of ventriculostomy-related hemorrhage after endovascular treatment and clipping.

Methods

A consecutive series of 99 patients treated for a ruptured aneurysm which required an external ventricular drainage between 2010 and 2015 were included. Their CT scans were investigated retrospectively for ventriculostomy-related hemorrhage. Furthermore, the extent of bleeding, the rate of revision surgery, and the rate of bacterial ventriculitis have been analyzed.

Results

Ventriculostomy-related hemorrhage was observed in 20 of 45 patients after endovascular treatment compared to 7 of 54 patients after clipping (chi-squared test, p < 0.001). Revision surgery was indicated in 75%. In 50% of these patients, revision surgery was required more than once and nearly 50% developed additional cerebral infections. Intraventricular or intracerebral extension of the bleeding was observed only in the endovascular treatment group (chi-squared test, p = 0.003). Glasgow outcome scale showed a significant better outcome in the surgical group (t test, p = 0.005).

Conclusions

Ventriculostomy-related hemorrhage is an underestimated complication after endovascular treatment leading to revision surgeries, bacterial infections, and may have a negative impact on long-term outcome. The probability of occurrence is increased when anticoagulation is performed by heparin in combination with antiplatelet drugs as compared to heparin alone. Lumbar drainage should be considered as an alternative for treatment of acute hydrocephalus in patients with Hunt and Hess grade 1–3.

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Title: Increased rate of ventriculostomy-related hemorrhage following endovascular treatment of ruptured aneurysms compared to clipping
Authors: Christian Scheller
Christian Strauss
Julian Prell
Sebastian Simmermacher
Silvio Brandt
Publication date: 01-03-2018
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 3/2018
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-018-3471-6

At a glance: The STEP trials

Springer Medicine

Increased rate of ventriculostomy-related hemorrhage following endovascular treatment of ruptured aneurysms compared to clipping

Abstract

Objective

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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