Rapid Pore Cranial Drilling With External Ventricular Drainage for Treatment of Intraventricular Hemorrhage: A 36-Year Case Series

This study aimed to describe the technique details of rapid pore cranial drilling with external ventricular drainage and document its clinical outcomes by highlighting the advantages over the traditional and modified cranial drilling technique. Intraventricular hemorrhage is one of the most severe subtypes of hemorrhagic stroke with high mortality. The amount of blood in the ventricles is associated with severity of outcomes, and fast removal of the blood clot is the key to a good prognosis. Between 1977 and 2013, 3773 patients admitted for intraventricular hemorrhage underwent rapid pore cranial drilling drainage. The therapeutic effects and clinical outcomes were retrospectively analyzed. Of these patients, 1049 (27.8%) experienced complete remission, 1788 (47.4%) had improved condition, and 936 (24.8%) died. A total of 3229 (85.6%) patients gained immediate remission. One typical case was illustrated to demonstrate the efficacy of the rapid pore drilling technique. Rapid pore cranial drilling drainage in patients with intraventricular hemorrhage is fast, effective, and provides immediate relief in patients with severe conditions. It could be a better alternative to the conventional drilling approach for treatment of intraventricular hemorrhage. A randomized controlled trial for direct comparison between the rapid pore cranial drilling drainage and conventional drilling technique is in urgent need.Key words: Intraventricular hemorrhage, External ventricular drainage, Rapid pore cranial drillingIntraventricular hemorrhage (IVH) denotes a bleeding within the ventricular system of the brain. It usually results from traumatic brain injuries or hemorrhagic stroke, and the prognosis can be very poor.^1,2 Volume of IVH has been reported to be a predictor of outcome in patients with spontaneous intracerebral hemorrhage (ICH) and extension to the ventricles.^3,4 Epidemiologic data has demonstrated a strong association between the amount of blood in the ventricles and severity of outcomes including mortality, coma, and functional impairment.⁴ This finding provides substantial support for the therapeutic idea of intraventricular hematoma removal, which has been validated in animal studies. The removal of blood clot from ventricles prevents hydrocephalus and inhibits inflammation mediated progressive tissue damage.^5,6 External ventricular drainage (EVD), also known as ventriculostomy, has then been developed to remove the blood or obstructed cerebrospinal fluid (CSF) from the ventricles of the brain, which thus relieves the elevated intracranial pressure (ICP) and hydrocephalus.⁷ Efforts have been made to improve the drilling and drainage techniques. For example, the method of percutaneous needle trephination has been introduced and performed in case of emergency as a simple, low-risk, effective way to reduce ICP.^8,9 Similarly, Zhang et al first introduced a medical device named rapid pore drilling apparatus in 1975, and shortly after reported the first success using the rapid pore drilling technique to perform EVD via the frontal horn of the lateral ventricle, which saved the life of a patient with IVH and severe tonsillar hernia.^10,11 It was a fast procedure, completed within 10 minutes, and could be performed at the bedside under sterile condition. Since then, this technique has been adopted in many hospitals in Shandong Province, China. In this study, we collected and analyzed clinical data on 3773 patients who were admitted for IVH at 14 hospitals from 1977 to 2013 and received rapid pore cranial drilling with EVD. The clinical experiences, including operating procedures, duration, technical performances, and the therapeutic effect of rapid pore drilling with EVD were recorded. To our best knowledge, the present study was the biggest one that involved the largest cohort so far and summarized the clinical practice of the rapid pore cranial drilling technique over 30 years. The results indicate that the rapid pore cranial drilling technique is minimally invasive, fast, safe, and effective for treating patients with severe IVH.