Interhemispheric transcorpus callosal approach in the treatment of ventricular hemorrhage with obstructive hydrocephalus

Background: Intraventricular hemorrhage, a frequent complication of intracerebral supratentorial hemorrhage, is associated with high rates of morbidity and mortality. Several methods have recently been developed for accelerating the clearance of intraventricular blood clots, especially during massive IVH. The present study was conducted to evaluate the interhemispheric, transcorpus callosal approach with septostomy for the management of supratentorial hemorrhage with intraventricular extension. Methods: Eighteen patients with primary IVH or thalamic/caudate hemorrhage complicated by IVH received an operation for removal of intraventricular blood clots by the interhemispheric, transcorpus callosal approach with septostomy. All patients received a brain CT examination before and after surgery. Clinical outcomes were assessed 6 months after surgery by the GOS. Results: Good clinical outcomes (GOS scores ≥4) were achieved in 45.6% of patients. In the patients with poor clinical outcome, the mean age was older (P = .001) and diabetes mellitus was more common (P = .04). Patients with thalamic hemorrhage with rupture into the third ventricle had worse clinical outcomes (P = .04). The overall mortality rate at 6 months postsurgery was 5.6%. Conclusion: The interhemispheric, transcorpus callosal approach with septostomy is safe and effective for direct removal of intraventricular blood clots during treatment of supratentorial hemorrhage with intraventricular extension. Further investigations involving more cases are needed to assess more fully the extent of improvement in clinical outcome attributable to this approach.