The intra-neuroendoscopic technique: a new method for rapid removal of acute severe intraventricular hematoma

The mortality rate of acute severe intraventricular hematoma is extremely high, and the rate of disability in survivors is high. Intraventricular hematoma has always been a difficult problem for clinical treatment. Although minimally invasive endoscopic hematoma evacuation is widely used to treat this disease, the technique still has room for improvement. Equipment for the intra-neuroendoscopic technique（INET） consists of two of our patented inventions： a transparent sheath（Patent No. ZL 200820046232.0） and a hematoma aspirator（Patent No. ZL 201520248717.8）. This study explored the safety and efficacy of INET by comparing it with extraventricular drainage in combination with urokinase thrombolytic therapy. This trial recruited 65 patients with severe intraventricular hemorrhage, including 35（19 men and 16 women, aged 53.2 ± 8.7 years） in the INET group and 30（17 men and 13 women, aged 51.5 ± 7.9 years） in the control group（extraventricular drainage plus urokinase thrombolytic therapy）. Our results showed that compared with the control group, the INET group exhibited lower intraventricular hemorrhage volumes, shorter intensive care-unit monitoring and ventricular drainage-tube placement times, and fewer incidences of intracranial infection, secondary bleeding, and mortality. Thus, the prognosis of survivors had improved remarkably. These findings indicate that INET is a safe and efficient new method for treating severe intraventricular hematoma. This trial was registered with Clinical Trials.gov（NCT02515903）.

Modified ventricular puncture combined with urokinase in the treatment of secondary intraventricular cast hemorrhage

Background: We introduce a new catheter-based minimally invasive approach via frontal tuber for removing hypertensive intraventricular hemorrhage(IVH), and further compare its treatment efficacy with conventional external ventricular drainage (EVD).Methods: This study is prospective and randomized.Sixty cases of secondary intraventricular cast hemorrhage patients were randomly divided into two groups of 30 cases: modified ventricular puncture (MVP) group and control group.Preoperative Glasgow coma scale (GCS) and Graeb score were compared between the two groups.The postoperative manifestations of two groups were also analyzed and compared statistically, including evacuation rate of intraventricular hematoma in 24 h, the time with drainage tube, rebleeding, complicated by infection, shunt-dependent hydrocephalus and Glasgow outcome scale at 3 months.Results: 1.There was no significant difference in preoperative GCS score and the Graeb score between two groups (P ＞ 0.05).2.In the MVP group via frontal tuber approach, a substantial removal of intraventricular hematoma was achieved in all cases.The average evacuation rate of intraventricular hematoma reached 80.10 ± 10.16 ％, the average time of catheter drainage was 3.17 ± 0.87 days, the average GOS was 3.80 ± 0.92, no intracranial infection and secondary hemorrhage were observed following surgery in all cases, and shunt-dependent hydrocephalus occurred in 2 cases.In the control group, the hematoma evacuation rate was an average of 21.21 ± 7.81％, the time of drainage was an average of 7.63 ± 2.87 days, the GOS was an average of 3.20 ± 1.12, intracranial infection after surgery occurred in 5 cases, secondary hemorrhage was observed in 1 case, and shunt-dependent hydrocephalus occurred in 8 cases.Between the two groups there were significantly statistical difference in the hematoma evacuation rate, drainage duration, infection rate and GOS (all P ＜ 0.05).Conclusions: The new approach is safe, and can quickly remove the hematoma, and significantly shorten the time with a pipe.It can also reduce the occurrence of infection and hydrocephalus, and improve overall outcome of patients, but cannot reduce mortality.

Place of Ultrasonographic in Screening Brain Lesions in Premature Newborn at Cotonou

Goal: The goal of this study is to define the epidemiological profile and identify the different brain lesions diagnosed in ultrasonography in preterm infants in Benin environment. Patients and methods: It is a prospective cross-sectional study of analytical aiming. It took place over a period of 6 months, from May 1st to October 31st, 2012 at the National Hospital University Centre Koutoukou Hubert Maga in neonatal units and medical scanning unit. It covered 105 premature newborn, classified into the very prematurity and the moderate prematurity. Results: The very premature represented 35.2% and the moderate premature 64.8%, with an average of 33.5% and 1.9 of standard deviation. The average age when implementing ultrasonographic transfontanellar was 7.2 ± 4.6 days old. The lowest birth weight was observed in very premature with p = 0.0025. The nasopharyngeal septum pellucidum was the most found lesions in 46 preterm infants (43.8%) with no statistically significantly difference in two groups, followed by the ventricular haemorrhage found in 21 preterm infants accounting for 20%, and the grade 1 or sub-ependymal haemorrhage prevailed in 14 premature accounting for 66.7%, afterward periventricular leukomalacia in 4 premature infants and hydrocephalus in 2 premature. Conclusion: The nasopharyngeal septum pellucidum and the sub-ependymal ventricular haemorrhage were the predominant anomalies in premature infants followed by leukomalacia.

Subarachnoid hemorrhage after surgery of the medulla oblongata hemangioblastoma:A case report

Objectives: To discuss the bleeding mechanisms after removing a medulla oblongata hemangioblastoma. Methods: A 42-year-old male patient was diagnosed with a medulla oblongata hemangioblastoma. Preoperative cranial magnetic resonance imaging, computed tomography angiography and post-surgery computed tomography were completed during clinical procedure. We also reviewed the related literatures. Results: The preoperative computed tomography angiography did not demonstrate any intracranial aneurysm. But, the patient had a fatal subarachnoid hemorrhage with ventricular hemorrhage 4 hours after surgery following the post-surgery computed tomography. Conclusions: Subarachnoid hemorrhage after surgery of the medulla oblongata hemangioblastoma is very rare. Delayed postoperative hemorrhage seems the most reasonable explanation of Subarachnoid hemorrhage in our case.