Surgical Management of Hemorrhagic Stroke with Intra-Ventricular Extension and Acute Obstructive Hydrocephalus: 12 Months Retrospective Review

Ugwuanyi CU, AnigboAA, Ogungbo B, Solanke O, Nwaribe EE, Ugwu E, Udoh LE, Onwuka SI and Jamgbadi SS

Neurosurgery Unit, National Hospital Abuja & Wellington Neurosurgery Centre Abuja, Nigeria
Neuroanasthesia Unit, National Hospital Abuja & Wellington Neurosurgery Centre Abuja, Nigeria
Neuroanasthesia Unit, Federal Medical Centre Abuja & Wellington Neurosurgery Centre Abuja, Nigeria

^*Correspondance to: Ugwuanyi CU 

 PDF  Full Text DOI: 10.25107/2474-1647.2095

Abstract

Background: Some clinicians believe that the mortality/morbidity associated with Intracerebral Hemorrhage (ICH) associated with Intracerebral Hemorrhage (IVH) and Acute Obstructive Hydrocephalus (AOHCP) does not justify any aggressive management, others think otherwise. Aims/
Objectives: To evaluate the impact of surgical intervention on the outcome of Hemorrhagic Stroke (HS) with IVH and AOHCP.Methods: 12 months retrospective review of case notes who met the selection criteria. Primary outcome measure was mortality. Secondary outcome was modified Rankin score (mRs) at discharge, at one month and at six months.Results: 15 patients (M: F=2.7:1) met the study criteria. Average age was 51years (age range =14-72 years). Headache and impaired consciousness were present in 100% cases. Hypertension was the most outstanding risk factor in 93% (n=14) cases with average Mean Arteria Blood Pressure (MABP) of 130 mmHg. Admitting brain CT scan showed ICH in 10/15 (66%) and SAH in 5/15(33%) cases. Both were associated with IVH and AOHCP. Hypertension was responsible for 9/10 (90%) of ICH while AVM contributed 10%. Most (77%) of the hypertensive bleeds (7/9) were deep (thalamic/basal ganglia). Aneurysm type by location favored (anterior communicating artery aneurysm) ACOM 3/5 (60%). EVD was inserted same day of admission with an average opening pressure of 52.9 cm H2O (38.6 mmHg) (Mean 52.9 cm H20, Std Dev=5.92 cm H20). Average duration on EVD was 6.6 days and 8/15 (63%) required conversion to VP shunts. 3/5 (60 %) of SAH patients had open craniotomy for clipping of aneurysm while 1/5 (20%) had endovascular coiling 5/10 (50%) of the ICH had conservative NCCU treatment but 2/10 (20%) merited craniotomy for clot evacuation. Mortality was 8/15 (53%).Conclusion: Mortality though still high, was comparatively reduced. None of the survivors returned to full functional status at six months. However early active management should not be discouraged where facilities exist.

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Cite the article

Ugwuanyi CU, Anigbo AA, Ogungbo B, Solanke O, Nwaribe EE, Ugwu E, et al. Surgical Management of Hemorrhagic Stroke with Intra-Ventricular Extension and Acute Obstructive Hydrocephalus: 12 Months Retrospective Review. Clin Surg. 2018; 3: 2095.