Shunt Dependency and Outcomes in Massive Intraventricular Hemorrhage
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Prevalence of Shunt Dependency and Clinical Outcome in Patients with Massive Intraventricular Haemorrhage Treated with Endoscopic Washout and External Ventricular Drainage
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Jason Raj Johnson, Zamzuri Idris, Jafri Malin Abdullah, Azmi Alias, Mohammad Saffari Mohammad Haspani
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Prevalence of Shunt Dependency and Clinical Outcome in Patients with Massive Intraventricular Haemorrhage Treated with Endoscopic Washout and External Ventricular Drainage
Year: 2017 | Doi: 10.21315/mjms2017.24.1.5
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
Intraventricular haemorrhage (IVH) is a severe condition often resulting from an extension of intracerebral haemorrhage (ICH) into the ventricular system, leading to complications such as hydrocephalus and increased intracranial pressure (ICP). The conventional treatment for IVH has involved the placement of an external ventricular drainage (EVD) catheter, which primarily addresses acute hydrocephalus. However, this method does not effectively clear intraventricular clots, which can result in ongoing complications. In contrast, endoscopic washout has emerged as a potential alternative that allows for more comprehensive removal of clots while addressing the underlying causes of IVH. This study aims to compare the clinical outcomes and shunt dependency between these two treatment approaches.
Significance of Endoscopic Washout
The results of the research revealed that patients treated with endoscopic washout exhibited significantly less drainage dependency than those who received EVD treatment at both two-week and three-month follow-ups. Additionally, the reduction in Graeb scores, which assess the extent of IVH, was notably greater in the endoscopic washout group, indicating a more effective resolution of the condition. However, while endoscopic washout provided better clinical outcomes in terms of reducing the need for additional drainage interventions, it did not result in significantly improved long-term functional outcomes, which were primarily influenced by the patients' initial Glasgow Coma Scale (GCS) scores and the nature of their underlying pathologies.
Conclusion
In conclusion, the study demonstrates that neuroendoscopic washing for massive IVH leads to a significant reduction in drainage dependency and promotes better initial recovery compared to traditional EVD. However, it highlights the complexity of long-term recovery, where factors such as the severity of the initial condition play a critical role in the functional outcomes. Ultimately, while endoscopic washout presents substantial advantages, the study indicates the necessity of refining patient selection criteria and further research to solidify its position in clinical practice for managing IVH.
FAQ section (important questions/answers):
What is intraventricular haemorrhage (IVH) and its effects?
Intraventricular haemorrhage (IVH) occurs when bleeding happens inside the brain's ventricles, causing blockage of cerebrospinal fluid pathways, which can lead to hydrocephalus, increased intracranial pressure, and decreased consciousness levels, significantly affecting patient outcomes.
What are the current treatments for intraventricular haemorrhage?
The standard treatment for IVH includes external ventricular drainage (EVD), which addresses acute hydrocephalus and intracranial pressure. However, it may not effectively resolve the underlying complications associated with the presence of blood clots in the ventricular system.
How does endoscopic washout differ from external ventricular drainage?
Endoscopic washout allows thorough removal of clots from the ventricles and may reduce drainage dependence better than EVD. This approach targets not only hydrocephalus but also addresses complications from blood clots more effectively, providing potential clinical benefits.
What were the main findings regarding functional outcomes after treatment?
While neuroendoscopy reduced shunt dependency and improved Graeb scores, it did not significantly alter long-term functional outcomes. Outcomes were more significantly influenced by initial Glasgow Coma Scale scores and the underlying pathology of the hemorrhage.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Shunt Dependency and Outcomes in Massive Intraventricular Hemorrhage”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Table:
A 'table' in the context of this study creates a structured summary of data, presenting information clearly for easy comparison. Tables are essential in research papers as they effectively display results, demographic data, and various outcomes, enhancing the reader's understanding of complex information at a glance and supporting the study's findings.
2) Study (Studying):
The term 'study' refers to a systematic investigation aimed at discovering and analyzing facts, principles, or phenomena. In this context, it denotes the research conducted to compare the clinical outcomes of endoscopic washout vs. external ventricular drainage in patients with intraventricular hemorrhage, ultimately contributing to medical knowledge and treatment efficacy.
3) Blood:
Blood is a crucial biological fluid that carries oxygen, nutrients, and waste products throughout the body. In this study, ‘blood’ specifically relates to intraventricular hemorrhage, where bleeding occurs within the brain's ventricular system. Understanding blood dynamics and clot resolution is vital for managing conditions like this and improving patient outcomes.
4) Post:
The term 'post' commonly refers to something occurring after a specific event. Here, it is used in the context of postoperative periods when monitoring patients after surgery. 'Post' evaluation in this study assesses recovery and clinical outcomes occurring after endoscopic or drainage procedures for patients with intraventricular hemorrhage.
5) Pur:
In a medical context, 'poor' often denotes low levels of function or unfavorable outcomes. In this study, 'poor' outcomes refer to patients with unsatisfactory recovery who may have significant disabilities as assessed by the modified Rankin scale. Recognizing 'poor' outcomes is essential for tailoring rehabilitation efforts and improving care strategies.
6) Filling (Filled):
The term 'filled' pertains to the extent to which the ventricles are occupied by blood or clot material in the case of intraventricular hemorrhage. Assessment of how 'filled' the ventricles are plays a crucial role in diagnosing the severity of hemorrhage, guiding treatment to alleviate complications like hydrocephalus.
7) Rules:
In this research, 'rules' may refer to the guidelines or criteria established for conducting the study, such as patient selection and treatment protocols. Rules are essential to ensure consistency and reliability in clinical trials, helping to define parameters that ensure the validity of the study's findings.
8) Incision:
An 'incision' is a surgical cut made during medical procedures. In this study, incisions are crucial for accessing the brain during the endoscopic washout or external ventricular drainage operations. The technique and precision of the incision directly impact recovery, complication rates, and the overall success of surgical interventions.
9) Channel:
The term 'channel' refers to a pathway, often implying an anatomical or procedural route. In the context of the study, it indicates the working channel used during endoscopic surgery for the evacuation of clots in the ventricular system. The effectiveness of this channel greatly influences surgical outcomes and recovery.
10) Disease:
'Disease' encompasses any condition that disrupts normal bodily functions, often exacerbating health challenges. In this study, it refers to the medical condition of patients suffering from intraventricular hemorrhage, a critical condition requiring prompt intervention. Understanding the disease's nature is essential for developing tailored treatment approaches to improve patient outcomes.
11) Coma:
Coma is a state of prolonged unconsciousness, often resulting from severe brain injuries or critical health conditions. In this study, the Glasgow Coma Scale is referenced to gauge patient responsiveness and consciousness level. Evaluating coma severity is vital for determining prognosis and potential recovery following interventions for intraventricular hemorrhage.
12) Sho (So):
The name 'Shao' appears to identify a contributing author in the context of the study. In academic papers, each author's contribution helps establish credibility and context for the research presented. Recognizing authors is valuable for acknowledging contributions and facilitating further investigation into their work and expertise within the field.
13) Male:
The term 'male' distinguishes one of the two primary biological sexes. In research studies, recognizing the gender breakdown of participants is crucial as it can influence health outcomes and responses to treatments. This study's demographic data aids in understanding how sex-specific factors may impact recovery in intraventricular hemorrhage patients.
14) Inflammation:
Inflammation is a biological response that can exhibit signs like redness, swelling, and pain. In the context of this study, inflammation is significant because of its role in the pathophysiology of intraventricular hemorrhage. Understanding inflammation within the brain can aid in developing strategies to minimize damage and improve healing.
15) Discussion:
The 'discussion' segment of a study synthesizes findings, contextualizing results within existing research. It critically analyzes the implications of the study's findings, addressing limitations and potential future directions. This section fosters understanding among researchers and clinicians about the significance of results and guides further inquiry into treatment approaches.
16) Family:
The term 'family' refers to the close relatives of the patients involved in the study, significant for medical history and support systems. In healthcare, involving family members in decision-making processes and consent is essential to patient care. Their understanding can impact a patient’s recovery and adherence to treatment plans.
17) Reason:
The term 'reason' indicates the underlying cause or rationale behind a treatment choice or patient condition. In this research, identifying reasons for selecting endoscopic interventions over external ventricular drainage provides insight into clinical decision-making processes, helping healthcare professionals understand strategies to optimize patient care and outcomes.
18) Indian:
The term 'Indian' refers to a specific ethnicity which contributes demographic context to the patient samples studied. Understanding ethnic diversity in clinical studies like this one is essential, as it enables the examination of potential variations in disease presentation, response to treatment, and overall health disparities within different populations.
19) Edema (Oedema):
Edema refers to the accumulation of fluid in tissues, often causing swelling. In the context of intraventricular hemorrhage, edema can complicate the patient's condition, elevating intracranial pressure and impacting recovery. Understanding the mechanisms of edema helps tailor treatment strategies to mitigate its effects and promote patient healing.
20) Death:
In the context of this study, 'death' signifies the most severe outcome of a critical health condition like intraventricular hemorrhage. Understanding mortality rates and risk factors is vital for assessing treatment efficacy, guiding clinical practices, and emphasizing the urgency of effective interventions in patients with this life-threatening condition.
21) Wall:
The term 'wall' likely refers to anatomical structures, such as the ventricular wall, involved in the pathology of intraventricular hemorrhage. Understanding the interactions between blood clots and surrounding walls is crucial for managing complications, as obstruction or damage to these areas can exacerbate conditions like hydrocephalus and impair recovery.
Other Science Concepts:
Discover the significance of concepts within the article: ‘Shunt Dependency and Outcomes in Massive Intraventricular Hemorrhage’. Further sources in the context of Science might help you critically compare this page with similair documents:
Functional outcome, Glasgow Coma Scale, Modified Rankin Scale, Intracranial Pressure, Emergency surgical intervention.