Effect Of Early External Ventricular Drainage On Perihemorrhagic Edema And Functional Outcome In Patients With Intraventricular Hemorrhage

Objective: External ventricular drainage(EVD)is the most common neurosurgical procedure that allows drainage of cerebral spinal fluid(CSF)and intraventricular blood from the ventricle.Specific time threshold for insertion of EVD catheter in spontaneous intracerebral hemorrhage(ICH)and intraventricular hemorrhage(IVH)has not been not established.This study aimed to evaluate the association of early external ventricular drainage(EEVD)with functional outcome in patients with on ICH and IVH.Methods: Patients were identified retrospectively from our institutional intracerebral hemorrhage(ICH)database from January 2017 to December 2021.We included patients who had baseline clinical,radiological,and laboratory data,and computed tomographic scan data and 6-month functional outcomes.According to the timing of the patient’s EVD operation,EEVD was defined as patients who received EVD within 8 hours after onset,while routine external ventricular drainage(REVD)represents patients who did not received any EVD procedure within 8 hours after onset.Propensity score(PS)matching(caliper0.2;one: many)was used to account for baseline imbalances.The modified Rankin Scale(mRS)at 3 and 6 months,mortality rates at 3 and 6 months,postoperative complications,time course of edema evolution and change in volume of PHE peak perihemorrhagic edema(PHE)were compared in the two groups of patients.Results: A total of 110 patients were included in the study;of which 50 patients were treated by EEVD and 60 patients by REVD.After propensity score matching,admission data between two groups were similar.For clinical functional outcomes,the rate of favorable outcome(mRS ≤3)at 3 months in the EEVD group was higher than that in the REVD group.(mRS 0-3,EEVD[50.0%] vs.REVD [23.1%],P=0.008).There were no differences in mRS at 6months(P>0.05),nor in mortality rates at 3 and 6 months between the two groups(P>0.05).For PHE evolution,volume of absolute peak PHE and r PHE in the EEVD group were significantly less than that in the REVD group(absolute peak PHE: EEVD 12.19±11.86 ml vs.REVD 19.92±15.53ml;P =0.011;r PHE: EEVD 1.27±1.38 ml vs.REVD 2.35±1.53 ml,P = 0.004).For postoperative complications,the incidences of postoperative infections in the EEVD group were lower than those in the REVD group(Infections,EEVD22/38 [57.9%] vs.REVD 41/52 [78.8%],P=0.032).However,EEVD did not affect incidence of rebleeding,seizures,or gastrointestinal bleeding events during the hospital stay(P>0.05).Conclusion: In our study,EEVD was associated with improved functional outcome at 3 months,reduced PHE and a lower rate of infection in ICH and IVH patients.However,this observation did not improve survival at 3 and 6months or functional outcome at 6 months.