External ventricular drainage for spontaneous intracranial haemorrhage with intraventricular extension in National Hospital Abuja

Abstract

Spontaneous intracerebral haemorrhage (ICH) accounts for 10 -15% of all cases of stroke and is associated with intraventricular extension in 40% of cases resulting in raised intracranial pressure from obstructive hydrocephalus.  The most common cause is uncontrolled hypertension. The presentation and prognosis depend on the location and size of haemorrhages.  External Ventricular Drainage (EVD) is a surgical means of temporary CSF diversion resulting in reduction of raised intracranial pressure (ICP) and remarkable improvement in clinical condition of patients.  The aim of the study was to retrospectively evaluate the outcome of surgical placement of EVD in patients with spontaneous intracranial haemorrhage and intraventricular extension in our centre over 19 months.

Sixty five percent of the 35 patients studied were male, with peak age group of 51 – 60 years and 80% were hypertensive. Majority of the haematoma (63%) was in the deep nuclei and 78% had haematoma volume greater than 30cm³ with significant midline shift. EVD placement was associated with good blood pressure control. Twenty-one patients (60%) had their EVD inserted more than 24 hours after onset of symptoms mostly because of financial constraint to purchase EVD set as occurred in 7 (33.3%) cases. However, mortality was high (68.6%) while only 17.1% of the patients had good recovery. Mortality found to be highest among patients with haematoma volume greater than 60mls (p = 0.008) and low GCS at admission (p = 0.012).

EVD is an emergency procedure commonly performed for spontaneous ICH in our centre. It is associated with significant reduction in blood pressure. The high mortality recorded is related to the severity of brain damage.

Keywords: intracerebral haemorrhage, external ventricular drainage,  hydrocephalus