Treatment of post-thalamic hemorrhage hydrocephalus: Ventriculoperitoneal shunt or endoscopic third ventriculostomy？

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Methods The clinical data of 87 patients with hydrocephalus after TH whose external ventricular drainage(EVD) cannot be removed after hematoma absorption were retrospectively analyzed. The patients were divided into the VPS and ETV groups according to the different surgical methods. The operative time, length of hospital stay, complications, and reoperation rates of the two groups were compared. Results There was no statistically significant difference in intraoperative bleeding and length of hospital stay between the two groups, and all patients had the EVD tube successfully removed after surgery. There were 4 (9.5%) complications in the ETV group and 3 (6.7%) complications in the VPS group, with no significant differences in postoperative complications between the two groups.During the 1-year follow up,7 patients (16.7%) in the ETV group and 3 patients (6.7%) in the VPS group required reoperation. There was a significant difference in the reoperation rates between the two groups. In the subgroup analysis of TH with fourth ventricular hemorrhage, 6 patients (14.3%) required reoperation in the ETV group, and 1 patient (2.2%) required reoperation in the VPS group; the difference between the two groups was statistically significant. Conclusions ETV have good efficacy in treating hydrocephalus caused by TH and TH breaking into the lateral ventricle and the third ventricle. However, if hydrocephalus is caused by TH with the fourth ventricular hematoma, VPS is a better surgical method because the recurrence rate of hydrocephalus in ETV is higher than that in VPS. Therefore, the choice of surgical method should be based on the patient’s clinical manifestations and hematoma type. Thalamic hemorrhage Hydrocephalus Ventriculoperitoneal shunt Endoscopic third ventriculostomy External ventricular drains Introduction Thalamic hemorrhage (TH) is a common type of hypertensive intracerebral hemorrhage (HICH), accounting for 8.3–15.0% of HICH [1,2], and it has a high rate of mortality and morbidity. Because of the special anatomical location of the thalamus, TH often obstructs the circulation of cerebrospinal fluid (CSF) and causes acute hydrocephalus due to the mass effect and hematoma breaking into the ventricle [3]. External ventricular drainage (EVD) can quickly alleviate acute hydrocephalus and provide treatment opportunities to save patients’ lives. EVD combined with urokinase treatment can cause intraventricular hematomas to disappear within a short time, reduce mortality, and improve patient prognosis [4]. However, due to long-term compression and local adhesion caused by hematoma metabolite reaction in the posterior part of the third ventricle and aqueduct, permanent cerebrospinal fluid circulation disorder is caused; thus, the EVD tube cannot be removed due to clamping failure, and cerebrospinal fluid (CSF) diversion is required. There are few studies on the treatment of post-TH hydrocephalus in which the EVD tube cannot be removed during treatment. Ventriculoperitoneal shunt (VPS) is the conventional treatment for post-hemorrhage hydrocephalus. However, With the placement of the VPS device, the potential for complications will be with the patient for life. ETV has also been recommended in some studies [5], but its effectiveness in post-hemorrhagic hydrocephalus is controversial [6,7,8]. Due to the unique location of TH and the accompanying different ventricular hematomas, in order to timely remove the EVD and minimize the drawbacks of surgical methods,it is necessary to carefully choose surgical methods based on the different situations of patients.Through a retrospective analysis of the clinical data of 87 patients with post-TH hydrocephalus treated in our hospital from January 2010 to September 2020, we aimed to discuss the value of different surgical schemes in the treatment of hydrocephalus after TH with failed clamping of the EVD tube to provide selective suggestions for clinical treatment. Materials and Methods Clinical data: The clinical data of 693 patients with HICH admitted to our hospital from January 2010 to September 2020 were analyzed retrospectively to compare the efficacy of VPS and ETV in the treatment of hydrocephalus after TH. According to the inclusion and exclusion criteria, a total of 87 patients were included in the study. Inclusion criteria: (1) clinical diagnosis of TH and underwent EVD; (2) complete records of clinical and imaging data before and after surgery. Exclusion criteria: (1) patients with brain herniation at admission and in a near-death state; (2) patients who have successfully removed EVD tubes after hematoma absorption; (3) patients with bleeding caused by organic pathology, arteriovenous malformations, Moyamoya disease, cerebral aneurysms, or traumatic events; (3) patients with preoperative coagulation disorders or hematologic disorders; (4) patients with severe mental illness; and (5) patients with incomplete clinical information. Criteria for failure to clamp the EVD tube: (1) computed tomography (CT) shows progressive dilation of the lateral ventricle; (2) increased intracranial pressure or hydrocephalus symptoms, such as drowsiness, headache, nausea, and vomiting. TH treatment: All patients were evaluated using CT at admission. When the thalamic hemorrhage exceeds 30ml, the patient's symptoms progressively worsen, puncture and aspiration of the hematoma was performed, and when a slight negative pressure occurred, the suction was stopped and an external drainage tube was placed. If TH broke into the ventricle or acute obstructive hydrocephalus was seen on CT, it was treated with EVD, and CT was performed within 24 hours after the operation. The remaining hematomas were liquefied and drained using an EVD combined with urokinase. After the intraventricular hematoma disappeared and 2 weeks after EVD, Before removing the EVD tube, we routinely clamp the EVD tube for 24 hours and CT to evaluate changes in the ventricles and whether CSF circulation is unobstructed.If the patient's lateral ventricle gradually expands, shows signs of high intracranial pressure, or progressive deterioration of consciousness, it is considered that the EVD tube cannot be removed. In order to alleviate the symptoms of hydrocephalus, we performed EVD on the contralateral side, the drainage tube intermittent clipping every day, and observed for 10–15 days. If EVD still cannot be removed, surgical treatment will be considered. Operative procedure: All surgeries were performed by the same surgical team, and patients and their caregivers were informed of the advantages and disadvantages of both surgical options. The choice of surgical option is based on the clinical experience of the surgeon and the choice of the caregivers. ETV group: All patients underwent endotracheal intubation and general anesthesia. Through the right frontal horn, lateral ventricle, interventricular foramen, and third ventricle, the lateral ventricle was punctured with an endoscopic puncture sheath, an endoscope was placed into the sheath to explore the ventricle, and ETV was performed. The site of the fistula was weakest in the triangular area in front of both papillae. First, a small hole was formed by bipolar electrocoagulation, then the dilated balloon catheter was placed into the hole, the fistula was expanded to 4–5 mm, the fistula was washed with 37°C balance liquid, water flow was observed, and it was confirmed that the fistula was unobstructed and fully communicated with the interpeduncular pool. VPS group All patients underwent endotracheal intubation and general anesthesia. A Medtronic adjustable pressure-drainage kit was used. The triangular area of the right lateral ventricle was punctured, the ventricular end of the shunt tube was placed, a pressure-regulating valve was connected, and the pressure-regulating valve was placed slightly above the back of the ear through the subcutaneous tunnel. Above the right side of the navel, the abdominal cavity was opened through a paramedian incision and the abdominal end of the shunt tube was led to the abdomen through the subcutaneous tunnel. After confirming that the drainage tube was unobstructed, the end of the shunt tube was placed in the abdominal cavity and fixed. All patients were routinely monitored for vital signs, a bed head elevation of 30°, rehydration, infection prevention, and other treatments after surgery. Postoperative evaluation All patients underwent a CT examination within 24 hours after surgery to assess postoperative intracranial conditions. Postoperative observation indicators included the operative time, hospitalization duration, and postoperative complications. Clinical success of surgery was assumed when the patient was followed alive and without subsequent hydrocephalus procedures, such as shunting. All patients were followed for 1 year. Informed consent: The institutional review board at People’s Hospital of Ningxia Hui Autonomous Region Hospital approved the study, which was granted a waiver for patients (or their guardians) consent owing to the retrospective nature of the present study. This research conforms with the Declaration of Helsinki. Data in this study will be made available on reasonable request Statistical analysis Continuous variables are expressed as mean±standard deviation or median. Differences between variables were evaluated using the independent sample t-test. Categorical variables are expressed as ratio (%), and differences between these variables were compared using the chi-square test. Data were analyzed using SPSS software, version 22.0 (IBM Corp.) and deemed significant if the P-value was <0.05 for all tests. Results Patient characteristics According to the inclusion and exclusion criteria, 87 patients were included in our study. 58 cases were male and 29 were female. Their ages ranged from 34 to 71 years, with a mean age of 53.2 ± 4.6 years; 31 patients had TH and 77 had a hematoma breaking into the ventricles, including the lateral and third ventricles in 56 cases and the fourth ventricle in 21 cases. Comparison of general conditions of patients between the ETV and VPS groups None of the patients died. There were no significant differences in age, previous diseases, type of bleeding, intraoperative blood loss, or length of hospital stay between the two groups (p > 0.05) (Table 1). The operative time in the VPS group was longer than that in the ETV group, and the difference between the two groups was statistically significant (p < 0.05). The EVD tube was successfully removed from all patients. Comparison of postoperative complications between the groups The ETV group included 13 cases (30.9%) of complications, 1 case of bleeding at the operative site, 2 case of fever, and 10 cases of pneumocephalus. The VPS group had 14 cases (31.1%) of complications, 1 case of bleeding at the operative site, 1 case of fever, 8 cases of pneumocephalus and 10 cases of Intracranial hypotension. All patients recovered after treatment, and there were no significant differences in postoperative complications between the two groups (Table 2). Comparison of reoperation rates between the groups after 1 year of follow-up During the 1-year follow-up, 7 patients (16.7%) in the ETV group required reoperation for the following reasons: fistula obstruction, 2 cases and communicating hydrocephalus, 5 cases. 3 patients (6.7%) in the VPS group required reoperation; the main reasons were as follows: shunt obstruction, 1 cases; bleeding at the operative site, 1 case; and intracranial infection, 1 case. The difference between the two groups was statistically significant (p < 0.05). In the subgroup analysis, TH with the fourth ventricular hemorrhage required reoperation in 6 cases (14.3%) in the ETV group and 1 case (2.2%) in the VPS group; the difference between the two groups was statistically significant (Table 3). Discussion Thalamic hemorrhage (TH) is very likely to break into the ventricles and compress the three ventricles and aqueduct, resulting in a disturbance of CSF circulation. EVD combined with urokinase can cause an intraventricular hematoma to disappear within a short time [9]. However, the hematoma in the thalamic parenchyma often does not disappear for a long time because of its deep location, the dilution of urokinase in CSF, and small interaction surface with the hematoma. Most patients with TH will have their CSF circulation restored after the hematoma is absorbed. However, in clinical practice, due to the compression of the hematoma and its surrounding edema and the role of local aseptic inflammation, adhesion and obstruction occurs in the rear of the third ventricle and the initial segment of the aqueduct, the hydrocephalus cannot be relieved after hematoma absorption and the EVD tube cannot be removed [10,11]. Because early removal of an intraventricular hematoma and remission of hydrocephalus can improve the mortality and prognosis of patients [12], most studies have focused on the treatment of acute hydrocephalus after hemorrhage.Due to the relatively small number of patients who cannot remove EVD after TH, Few studies have investigated the treatment of post-TH hydrocephalus. Indwelling the EVD tube for a long time will not only increase complications, such as intracranial infection and hemorrhage, but will also affect the rehabilitation of patients. At present, VPS is widely used for the treatment of hydrocephalus, especially for the treatment of post-hemorrhage hydrocephalus [13]. However, postoperative complications, such as infection and blockage, can easily lead to operative failure, which is difficult to avoid. In the VPS group, 2 patients (4.4%) had shunt obstruction and 1 patient (2.2%) had an infection. In order to reduce the incidence of complications, ETV has emerged as an alternative treatment for hydrocephalus [14]. Over the past few decades, this technique has been refined and has become a frequently used tool in the treatment of hydrocephalus [15,16,17,18.]. Compared with VPS, ETV is more in line with the physiological process of CSF circulation; it overcomes complications such as shunt tube blockage, shunt tube exposure, and the psychological burden caused by internal tube placement on the patient. Because of its high success rate and small complications, ETV has been the preferred treatment for obstructive hydrocephalus [19]; however, ETV also has the risk of intracranial infection and fistula obstruction, and the curative effect of communicating hydrocephalus remains controversial [6,8]. In the ETV group, postoperative complications occurred in 4 patients, including 1 cases of bleeding at the operative site, 1 case of intracranial infection, and 2 cases of fistula obstruction. There was no significant difference in postoperative complications between the two groups. The operative time of VPS was longer than that of ETV, and the difference between the groups was statistically significant. Post-TH hydrocephalus is mainly obstructive hydrocephalus. Therefore, ETV seems to be more suitable for post-TH hydrocephalus than VPS. Hussein et al. conducted ETV in 8 patients with TH, who could not remove EVD tube could not be removed because of hydrocephalus. Those patients were followed up for 3 months, and ETV was considered to be a safe and effective method for the treatment of hydrocephalus after TH [20]. However, TH can easily break into the ventricle, and the results differ according to the hematoma location. If the hematoma is located in the thalamus or only breaks into the lateral ventricle and third ventricle, the patient has obstructive hydrocephalus after EVD + urokinase drainage. If TH is accompanied by fourth ventricle hematoma, the effect of urokinase is poor due to midbrain aqueduct obstruction. The fourth ventricle hematoma is absorbed through the subarachnoid space after catabolism, and communicating hydrocephalus occurs easily in the later stage. Regarding communicating hydrocephalus, the failure rate of ETV is high because its pathogenesis is an obstacle to the subarachnoid reabsorption of CSF [21,22]. Obaid et al., Carter et al., and Siomin et al. concluded that the failure rate of ETV will be greatly increased in hydrocephalus caused by intraventricular hemorrhage [21, 23, 24]. Our study’s result supports this view. In patients with TH and hemorrhage breaking into the lateral and third ventricles, the reoperation rate of ETV was 2.4%, and the reoperation rate of VPS was 2.4%, with no significant difference between the groups. However, in TH with fourth ventricle hemorrhage, the reoperation rate of ETV was 14.3%, and that of VPS was 2.2%. To achieve a good surgical effect and reduce the reoperation rate after surgery, the bleeding type of patients must be analyzed. We concluded that 1) TH and/or intraventricular hemorrhage only exists in the lateral and third ventricles because hydrocephalus is an obstructive hydrocephalus caused by the compression of hematoma and adhesion, which is more suitable for ETV. 2) TH and hematoma in the fourth ventricle are more likely to develop into communicating hydrocephalus in the later stage, even if they show obstructive hydrocephalus in the early stage. The long-term effect of ETV was poor and the reoperation rate was high in such cases. Therefore, this type of patients is suitable for VPS. Limitations The present study has some limitations. First, it was a retrospective analysis, and some of the indicators obtained were not comprehensive and may be biased; further, more comprehensive data collection and analysis are needed. Second, there was a lack of prospective analysis, and the sample size was small(TH is common, but cases cases whose EVD cannot be removed after TH are relatively rare). Third, the ETV and VPS cases were evaluated retrospectively on the basis of clinical records, and the postoperative follow-up was only 1 year; thus, this study lacked long-term follow-up. In addition, and the study design had certain errors and limitations, which need to be further improved in subsequent studies. Conclusions ETV have good efficacy in treating hydrocephalus caused by TH and TH breaking into the lateral ventricle and the third ventricle. However, if hydrocephalus is caused by TH with the fourth ventricular hematoma, VPS is a better surgical method because the recurrence rate of hydrocephalus in ETV is higher than that in VPS. Therefore, the choice of surgical method should be based on the patient’s clinical manifestations and hematoma type. Abbreviations VPS: ventriculoperitoneal shunt; ETV: endoscopic third ventriculostomy; TH: thalamic hemorrhage; EVD: external ventricular drainage; HICH: hypertensive intracerebral hemorrhage; CSF: cerebrospinal fluid; CT: computed tomography. Declarations Ethical Approval ： The institutional review board at People’s Hospital of Ningxia Hui Autonomous Region Hospital approved the study. This research conforms with the Declaration of Helsinki. Data in this study will be made available on reasonable request. Consent for publication: Not Applicable. Availability of data and materials ： The data that support the findings of this study are available from the corresponding author upon reasonable request. Competing interests ： There is no conflict of interest. Funding ： This study has received no financial support. Authors' contributions ： WC. L.: Data collection and statistical analysis, wrote the main manuscript. AD.D.: Data collection and revision of the manuscript. XM.Z.:Design of the study; confirmed the results of the statistical analysis. The authors read and approved the final manuscript. Acknowledgements: The authors thank the nurses for providing useful advice and cooperation. References Taek Min Nam, Ji Hwan Jang, Seung Hwan Kim, Kyu Hong Kim, Young Zoon Kim comparative analysis of the patients with spontaneous thalamic hemorrhage with concurrent intraventricular hemorrhage and those without intraventricular hemorrhage.[J] J Korean Med Sci. 2021; 36(1):e4. Lee SH, Park KJ, Kang SH, Jung YG, Park JY, Park DH. Prognostic factors of clinical outcomes in patients with spontaneous thalamic hemorrhage. Med Sci Monit. 2015; 21:2638-2646. Brandon L. Neisewander Location of Thalamic Hemorrhage Impacts Prognosis.[J] World neurosurgery 2018;116: e525-e533. Mei Li, Fengqun Mu, Qian Han, Dongpo Su, Zhenzhong Guo, Tong Chen Intraventricular fibrinolytic for the treatment of intraventricular hemorrhage: a network meta-analysis.[J] Brain Inj 2020; 34(7):864-870 Vogel TW, Bahuleyan B, Robinson S, Cohen AR. The role of endoscopic third ventriculostomy in the treatment of hydrocephalus. [J] J Neurosurg Pediatr. 2013; 12(1):54-61 Fukuhara T, Shimizu T, Namba Y. Limited efficacy of endoscopic third ventriculostomy for hydrocephalus following aneurysmal subarachnoid hemorrhage. [J]Neurol Med Chir (Tokyo). 2009;49(10):449-55. Hailong F, Guangfu H, Haibin T, Hong P, Yong C, Weidong L, Dongdong Z. Endoscopic third ventriculostomy in the management of communicating hydrocephalus: a preliminary study.[J]J Neurosurg. 2008;109(5):923-30 Rangel-Castilla L, Barber S, Zhang YJ.The role of endoscopic third ventriculostomy in the treatment of communicating hydrocephalus.[J]World Neurosurg. 2012;77(3-4):555-60. Holly E Hinson, Daniel F Hanley, Wendy C Ziai Management of intraventricular hemorrhage. Curr Neurol Neurosci Rep. 2010; 10(2):73-82 Zacharia BE, Vaughan KA, Hickman ZL, et al. Predictors of long-term shuntdependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion. Neurosurg Focus. 2012; 32(4):E5. Kuo L-T, Lu H-Y, Tsai J-C, Tu Y-K. Prediction of shunt dependency after intracerebral hemorrhage and intraventricular hemorrhage. Neurocrit Care. 2018; 29(2):233-240. Paul Wrigh, Deborah R. Horowitz Clinical Improvement Related to Thrombolysis of Third Ventricular Blood Clot in a Patient With Thalamic Hemorrhage.[J] Journal of Stroke and Cerebrovascular Diseases 2001; 10(1):23-26. Greenberg M. Handbook of Neurosurgery. 8th. New York: Thieme Medical Publisher; 2016. Riegel T, Hellwig D, Bauer BL, Mennel HD Endoscopic anatomy of the third ventricle. Acta Neurochir Suppl. 1994;61:54-6. K. Abhari, S. de Ribaupierre, T. Peters, R. Eagleson, Evaluation of a VR and stereoendoscopic tool to facilitate 3rd ventriculostomy, Stud. Health technol. Inform.2011;1631–7. A. Amini, R.H. Schmidt, Endoscopic third ventriculostomy in a series of 36 adult patients, Neurosurg. Focus. 2005;19 (6): E9. N.K. Venkataramana, S.A. Rao, A.L. Naik, Endoscopic third ventriculostomy, J. Pediatr. Neurosci. 2009; 4 (2): 108–112. M.L. Walker, History of ventriculostomy, Neurosurg. Clin. N. Am. 2001;12(1): 101–110. Gan gemiM．Dotmti P，Maiuri F，et a1．Endoscopicthird ventriculostomy for hydrocephalus．Minim lnvasive Neurosurg．1999;42: l28-l32． Hussein A Zeineddine, Antonio Dono, Ryan Kitagawa, Sean I Savitz, Huimahn Alex Choi, et al. Endoscopic Third Ventriculostomy for Hydrocephalus Secondary to Extraventricular Obstruction in Thalamic Hemorrhage:A Case Series.[J] Oper Neurosurg (Hagerstown). 2020; 19(4):384-392. S. Obaid, A.G. Weil, R. Rahme, M.W. Bojanowski, Endoscopic third ventriculostomy for obstructive hydrocephalus due to intraventricular hemorrhage, J. Neurol. Surg. A Cent. Eur. Neurosurg. 2015; 76 (2):99–111. D. Bouramas, N. Paidakakos, F. Sotiriou, K. Kouzounias, M. Sklavounou, N. Gekas,Endoscopic third ventriculostomy in obstructive hydrocephalus: surgical technique and pitfalls, Acta Neurochir. Suppl. 2012;113:135–139. J.E. Carter, K.N. Mizell, T.N. Evans, Neisseria sicca meningitis following intracranial hemorrhage and ventriculostomy tube placement, Clin. Neurol. 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Tables Table 1 Comparison of general clinical data between the two groups ETV(n = 42) VPS(n = 45) P value Gender 1.000 Male 28 30 Female 14 15 Age (y) 52.4 ± 6.5 54.1 ± 2.5 0.107 Previous disease: 0.983 Hypertension (%) 34(80.9%) 40(88.9%) Heart disease (%) 18(42.9%) 20(44.4%) Diabetes (%) 19(45.2%) 21(46.7%) TH (%) 16 15 0.612 TH break into the ventricles (%) 0.799 Lateral ventricle and third ventricle 26 30 Fourth ventricles 11 10 Operation times (min) 35.2 ± 5.1 82.4 ± 3.8 0.001 Intraoperative blood loss (ml) 57.1 ± 6.6 60.4 ± 4.3 0.007 Hospital stay (d) 14.3 ± 4.4 13.6 ± 3.1 0.391 VPS: ventriculoperitoneal shunt; ETV: endoscopic third ventriculostomy; TH: thalamic hemorrhage. Table 2 Comparison of postoperative complications between the two groups ETV(n,%) VPS(n,%) Bleeding at the operation site 1(2.4) 1(2.2) Fever 2(4.8) 1(2.2) Pneumocephalus 10(23.8) 8(17.8) Intracranial hypotension 0(0) 2(4.4) VPS: ventriculoperitoneal shunt; ETV: endoscopic third ventriculostomy. Table 3 Comparison of the reoperation rate between the two groups after 1 year of follow-up ETV(n,%) VPS(n,%) P value TH 1(2.4) 1(2.2) 0.961 TH break into the ventricles (%) Lateral ventricle and third ventricle 0(0) 1(2.2) 0.331 Fourth ventricle 6(14.3) 1(2.2) 0.039 VPS: ventriculoperitoneal shunt; ETV: endoscopic third ventriculostomy; TH: thalamic hemorrhage. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 28 Sep, 2024 Read the published version in BMC Neurology → Version 1 posted Editorial decision: Revision requested 12 Feb, 2024 Reviews received at journal 05 Jan, 2024 Reviewers agreed at journal 04 Jan, 2024 Reviewers invited by journal 04 Jan, 2024 Editor invited by journal 04 Jan, 2024 Editor assigned by journal 04 Jan, 2024 Submission checks completed at journal 04 Jan, 2024 First submitted to journal 04 Jan, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3834029","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":265677418,"identity":"432aec33-2653-4cf1-871a-6906e9c6e054","order_by":0,"name":"Wenchao Lu","email":"","orcid":"","institution":"Clinical Medicine School of Ningxia Medical University, Ningxia Hui Autonomous Region","correspondingAuthor":false,"prefix":"","firstName":"Wenchao","middleName":"","lastName":"Lu","suffix":""},{"id":265677419,"identity":"e9fa42f9-f8e9-4c57-8221-dc9b056d30cd","order_by":1,"name":"Andong Du","email":"","orcid":"","institution":"People’s Hospital of Ningxia Hui Autonomous Region","correspondingAuthor":false,"prefix":"","firstName":"Andong","middleName":"","lastName":"Du","suffix":""},{"id":265677420,"identity":"0b872478-f530-47ab-9627-5e46b7f69136","order_by":2,"name":"Xiaomin Zheng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIie3RsQqCYBDA8U8EXQxXRbAnCE6EwMUn6CFOgiZpaXErCJrMGh18i8D5QHCy3VEJmlwaWyrHmvzagr7//uO4O8ZEoh9srB4uDUbPta5viY84caVAU8lopiVyjqlnzGx3MgKFwCekdESAirIEqm51x3x7shkgqpVgg5q2Mov9ycvY3J3S0JSMANAwpITOuaUxCvIhwmoEAwGkDYVXXhL2BDE4UqjwEScuF4BEbn9k18uAY5exui3a+4Ps/pVt3UW+PUg+MjTO17yTb4VIJBL9RS+l50m23W5ihAAAAABJRU5ErkJggg==","orcid":"","institution":"People’s Hospital of Ningxia Hui Autonomous Region, Ningxia Hui Autonomous Region","correspondingAuthor":true,"prefix":"","firstName":"Xiaomin","middleName":"","lastName":"Zheng","suffix":""}],"badges":[],"createdAt":"2024-01-04 08:29:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3834029/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3834029/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12883-024-03880-0","type":"published","date":"2024-09-28T15:57:29+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":65627223,"identity":"2c0b0fdd-b607-4557-b242-bfa6dbec2251","added_by":"auto","created_at":"2024-09-30 16:13:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":350812,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3834029/v1/24271069-9e52-4513-85bd-ea21b3cd2298.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Treatment of post-thalamic hemorrhage hydrocephalus: Ventriculoperitoneal shunt or endoscopic third ventriculostomy？","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThalamic hemorrhage (TH) is a common type of hypertensive intracerebral hemorrhage (HICH), accounting for 8.3\u0026ndash;15.0% of HICH [1,2], and it has a high rate of mortality and morbidity. Because of the special anatomical location of the thalamus, TH often obstructs the circulation of cerebrospinal fluid (CSF) and causes acute hydrocephalus due to the mass effect and hematoma breaking into the ventricle [3]. External ventricular drainage (EVD) can quickly alleviate acute hydrocephalus and provide treatment opportunities to save patients\u0026rsquo; lives. EVD combined with urokinase treatment can cause intraventricular hematomas to disappear within a short time, reduce mortality, and improve patient prognosis [4]. However, due to long-term compression and local adhesion caused by hematoma metabolite reaction in the posterior part of the third ventricle and aqueduct, permanent cerebrospinal fluid circulation disorder is caused; thus, the EVD tube cannot be removed due to clamping failure, and cerebrospinal fluid (CSF) diversion is required.\u003c/p\u003e \u003cp\u003eThere are few studies on the treatment of post-TH hydrocephalus in which the EVD tube cannot be removed during treatment. Ventriculoperitoneal shunt (VPS) is the conventional treatment for post-hemorrhage hydrocephalus. However, With the placement of the VPS device, the potential for complications will be with the patient for life. ETV has also been recommended in some studies [5], but its effectiveness in post-hemorrhagic hydrocephalus is controversial [6,7,8]. Due to the unique location of TH and the accompanying different ventricular hematomas, in order to timely remove the EVD and minimize the drawbacks of surgical methods,it is necessary to carefully choose surgical methods based on the different situations of patients.Through a retrospective analysis of the clinical data of 87 patients with post-TH hydrocephalus treated in our hospital from January 2010 to September 2020, we aimed to discuss the value of different surgical schemes in the treatment of hydrocephalus after TH with failed clamping of the EVD tube to provide selective suggestions for clinical treatment.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eClinical data: The clinical data of 693 patients with HICH admitted to our hospital from January 2010 to September 2020 were analyzed retrospectively to compare the efficacy of VPS and ETV in the treatment of hydrocephalus after TH. According to the inclusion and exclusion criteria, a total of 87 patients were included in the study.\u003c/p\u003e\n\u003cp\u003eInclusion criteria: (1) clinical diagnosis of TH and underwent EVD; (2) complete records of clinical and imaging data before and after surgery.\u003c/p\u003e\n\u003cp\u003eExclusion criteria: (1) patients with brain herniation at admission and in a near-death state; (2) patients who have successfully removed EVD tubes after hematoma absorption; (3) patients with bleeding caused by organic pathology, arteriovenous malformations, Moyamoya disease, cerebral aneurysms, or traumatic events; (3) patients with preoperative coagulation disorders or hematologic disorders; (4) patients with severe mental illness; and (5) patients with incomplete clinical information.\u003c/p\u003e\n\u003cp\u003eCriteria for failure to clamp the EVD tube: (1) computed tomography (CT) shows progressive dilation of the lateral ventricle; (2) increased intracranial pressure or hydrocephalus symptoms, such as drowsiness, headache, nausea, and vomiting.\u003c/p\u003e\n\u003cp\u003eTH treatment:\u003c/p\u003e\n\u003cp\u003eAll patients were evaluated using CT at admission. When the thalamic hemorrhage exceeds 30ml, the patient\u0026apos;s symptoms progressively worsen, puncture and aspiration of the hematoma was performed, and when a slight negative pressure occurred, the suction was stopped and an external drainage tube was placed. If TH broke into the ventricle or acute obstructive hydrocephalus was seen on CT, it was treated with EVD, and CT was performed within 24 hours after the operation. The remaining hematomas were liquefied and drained using an EVD combined with urokinase.\u003c/p\u003e\n\u003cp\u003eAfter the intraventricular hematoma disappeared and 2 weeks after EVD, Before removing the EVD tube, we routinely clamp the EVD tube for 24 hours and CT to evaluate changes in the ventricles and whether CSF circulation is unobstructed.If the patient\u0026apos;s lateral ventricle gradually expands, shows signs of high intracranial pressure, or progressive deterioration of consciousness, it is considered that the EVD tube cannot be removed. In order to alleviate the symptoms of hydrocephalus, we performed EVD on the contralateral side, the drainage tube intermittent clipping every day, and observed for 10\u0026ndash;15 days. If EVD still cannot be removed, surgical treatment will be considered.\u003c/p\u003e\n\u003cp\u003eOperative procedure:\u003c/p\u003e\n\u003cp\u003eAll surgeries were performed by the same surgical team, and patients and their caregivers were informed of the advantages and disadvantages of both surgical options. The choice of surgical option is based on the clinical experience of the surgeon and the choice of the caregivers.\u003c/p\u003e\n\u003cp\u003eETV group:\u003c/p\u003e\n\u003cp\u003eAll patients underwent endotracheal intubation and general anesthesia. Through the right frontal horn, lateral ventricle, interventricular foramen, and third ventricle, the lateral ventricle was punctured with an endoscopic puncture sheath, an endoscope was placed into the sheath to explore the ventricle, and ETV was performed. The site of the fistula was weakest in the triangular area in front of both papillae. First, a small hole was formed by bipolar electrocoagulation, then the dilated balloon catheter was placed into the hole, the fistula was expanded to 4\u0026ndash;5 mm, the fistula was washed with 37\u0026deg;C balance liquid, water flow was observed, and it was confirmed that the fistula was unobstructed and fully communicated with the interpeduncular pool.\u003c/p\u003e\n\u003cp\u003eVPS group\u003c/p\u003e\n\u003cp\u003eAll patients underwent endotracheal intubation and general anesthesia. A Medtronic adjustable pressure-drainage kit was used. The triangular area of the right lateral ventricle was punctured, the ventricular end of the shunt tube was placed, a pressure-regulating valve was connected, and the pressure-regulating valve was placed slightly above the back of the ear through the subcutaneous tunnel. Above the right side of the navel, the abdominal cavity was opened through a paramedian incision and the abdominal end of the shunt tube was led to the abdomen through the subcutaneous tunnel. After confirming that the drainage tube was unobstructed, the end of the shunt tube was placed in the abdominal cavity and fixed.\u003c/p\u003e\n\u003cp\u003eAll patients were routinely monitored for vital signs, a bed head elevation of 30\u0026deg;, rehydration, infection prevention, and other treatments after surgery.\u003c/p\u003e\n\u003cp\u003ePostoperative evaluation\u003c/p\u003e\n\u003cp\u003eAll patients underwent a CT examination within 24 hours after surgery to assess postoperative intracranial conditions. Postoperative observation indicators included the operative time, hospitalization duration, and postoperative complications. Clinical success of surgery was assumed when the patient was followed alive and without subsequent hydrocephalus procedures, such as shunting. All patients were followed for 1 year.\u003c/p\u003e\n\u003cp\u003eInformed consent: The institutional review board at People\u0026rsquo;s Hospital of Ningxia Hui Autonomous Region Hospital approved the study, which was granted a waiver for patients (or their guardians) consent owing to the retrospective nature of the present study. This research conforms with the Declaration of Helsinki. Data in this study will be made available on reasonable request\u003c/p\u003e\n\u003cp\u003eStatistical analysis\u003c/p\u003e\n\u003cp\u003eContinuous variables are expressed as mean\u0026plusmn;standard deviation or median. Differences between variables were evaluated using the independent sample t-test. Categorical variables are expressed as ratio (%), and differences between these variables were compared using the chi-square test. Data were analyzed using SPSS software, version 22.0 (IBM Corp.) and deemed significant if the P-value was \u0026lt;0.05 for all tests.\u003c/p\u003e"},{"header":"Results ","content":"\u003cp\u003ePatient characteristics\u003c/p\u003e\n\u003cp\u003eAccording to the inclusion and exclusion criteria, 87 patients were included in our study. 58 cases were male and 29 were female. Their ages ranged from 34 to 71 years, with a mean age of 53.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6 years; 31 patients had TH and 77 had a hematoma breaking into the ventricles, including the lateral and third ventricles in 56 cases and the fourth ventricle in 21 cases.\u003c/p\u003e\n\u003cp\u003eComparison of general conditions of patients between the ETV and VPS groups\u003c/p\u003e\n\u003cp\u003eNone of the patients died. There were no significant differences in age, previous diseases, type of bleeding, intraoperative blood loss, or length of hospital stay between the two groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;1). The operative time in the VPS group was longer than that in the ETV group, and the difference between the two groups was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The EVD tube was successfully removed from all patients.\u003c/p\u003e\n\u003cp\u003eComparison of postoperative complications between the groups\u003c/p\u003e\n\u003cp\u003eThe ETV group included 13 cases (30.9%) of complications, 1 case of bleeding at the operative site, 2 case of fever, and 10 cases of pneumocephalus. The VPS group had 14 cases (31.1%) of complications, 1 case of bleeding at the operative site, 1 case of fever, 8 cases of pneumocephalus and 10 cases of Intracranial hypotension. All patients recovered after treatment, and there were no significant differences in postoperative complications between the two groups (Table\u0026nbsp;2).\u003c/p\u003e\n\u003cp\u003eComparison of reoperation rates between the groups after 1 year of follow-up\u003c/p\u003e\n\u003cp\u003eDuring the 1-year follow-up, 7 patients (16.7%) in the ETV group required reoperation for the following reasons: fistula obstruction, 2 cases and communicating hydrocephalus, 5 cases. 3 patients (6.7%) in the VPS group required reoperation; the main reasons were as follows: shunt obstruction, 1 cases; bleeding at the operative site, 1 case; and intracranial infection, 1 case. The difference between the two groups was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In the subgroup analysis, TH with the fourth ventricular hemorrhage required reoperation in 6 cases (14.3%) in the ETV group and 1 case (2.2%) in the VPS group; the difference between the two groups was statistically significant (Table\u0026nbsp;3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThalamic hemorrhage (TH) is very likely to break into the ventricles and compress the three ventricles and aqueduct, resulting in a disturbance of CSF circulation. EVD combined with urokinase can cause an intraventricular hematoma to disappear within a short time [9]. However, the hematoma in the thalamic parenchyma often does not disappear for a long time because of its deep location, the dilution of urokinase in CSF, and small interaction surface with the hematoma. Most patients with TH will have their CSF circulation restored after the hematoma is absorbed. However, in clinical practice, due to the compression of the hematoma and its surrounding edema and the role of local aseptic inflammation, adhesion and obstruction occurs in the rear of the third ventricle and the initial segment of the aqueduct, the hydrocephalus cannot be relieved after hematoma absorption and the EVD tube cannot be removed [10,11]. Because early removal of an intraventricular hematoma and remission of hydrocephalus can improve the mortality and prognosis of patients [12], most studies have focused on the treatment of acute hydrocephalus after hemorrhage.Due to the relatively small number of patients who cannot remove EVD after TH, Few studies have investigated the treatment of post-TH hydrocephalus. Indwelling the EVD tube for a long time will not only increase complications, such as intracranial infection and hemorrhage, but will also affect the rehabilitation of patients.\u003c/p\u003e\n\u003cp\u003eAt present, VPS is widely used for the treatment of hydrocephalus, especially for the treatment of post-hemorrhage hydrocephalus [13]. However, postoperative complications, such as infection and blockage, can easily lead to operative failure, which is difficult to avoid. In the VPS group, 2 patients (4.4%) had shunt obstruction and 1 patient (2.2%) had an infection. In order to reduce the incidence of complications, ETV has emerged as an alternative treatment for hydrocephalus [14]. Over the past few decades, this technique has been refined and has become a frequently used tool in the treatment of hydrocephalus [15,16,17,18.]. Compared with VPS, ETV is more in line with the physiological process of CSF circulation; it overcomes complications such as shunt tube blockage, shunt tube exposure, and the psychological burden caused by internal tube placement on the patient. Because of its high success rate and small complications, ETV has been the preferred treatment for obstructive hydrocephalus [19]; however, ETV also has the risk of intracranial infection and fistula obstruction, and the curative effect of communicating hydrocephalus remains controversial [6,8]. In the ETV group, postoperative complications occurred in 4 patients, including 1 cases of bleeding at the operative site, 1 case of intracranial infection, and 2 cases of fistula obstruction. There was no significant difference in postoperative complications between the two groups. The operative time of VPS was longer than that of ETV, and the difference between the groups was statistically significant.\u003c/p\u003e\n\u003cp\u003ePost-TH hydrocephalus is mainly obstructive hydrocephalus. Therefore, ETV seems to be more suitable for post-TH hydrocephalus than VPS. Hussein et al. conducted ETV in 8 patients with TH, who could not remove EVD tube could not be removed because of hydrocephalus. Those patients were followed up for 3 months, and ETV was considered to be a safe and effective method for the treatment of hydrocephalus after TH [20]. However, TH can easily break into the ventricle, and the results differ according to the hematoma location. If the hematoma is located in the thalamus or only breaks into the lateral ventricle and third ventricle, the patient has obstructive hydrocephalus after EVD\u0026thinsp;+\u0026thinsp;urokinase drainage. If TH is accompanied by fourth ventricle hematoma, the effect of urokinase is poor due to midbrain aqueduct obstruction. The fourth ventricle hematoma is absorbed through the subarachnoid space after catabolism, and communicating hydrocephalus occurs easily in the later stage. Regarding communicating hydrocephalus, the failure rate of ETV is high because its pathogenesis is an obstacle to the subarachnoid reabsorption of CSF [21,22]. Obaid et al., Carter et al., and Siomin et al. concluded that the failure rate of ETV will be greatly increased in hydrocephalus caused by intraventricular hemorrhage [21, 23, 24]. Our study\u0026rsquo;s result supports this view. In patients with TH and hemorrhage breaking into the lateral and third ventricles, the reoperation rate of ETV was 2.4%, and the reoperation rate of VPS was 2.4%, with no significant difference between the groups. However, in TH with fourth ventricle hemorrhage, the reoperation rate of ETV was 14.3%, and that of VPS was 2.2%.\u003c/p\u003e\n\u003cp\u003eTo achieve a good surgical effect and reduce the reoperation rate after surgery, the bleeding type of patients must be analyzed. We concluded that 1) TH and/or intraventricular hemorrhage only exists in the lateral and third ventricles because hydrocephalus is an obstructive hydrocephalus caused by the compression of hematoma and adhesion, which is more suitable for ETV. 2) TH and hematoma in the fourth ventricle are more likely to develop into communicating hydrocephalus in the later stage, even if they show obstructive hydrocephalus in the early stage. The long-term effect of ETV was poor and the reoperation rate was high in such cases. Therefore, this type of patients is suitable for VPS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study has some limitations. First, it was a retrospective analysis, and some of the indicators obtained were not comprehensive and may be biased; further, more comprehensive data collection and analysis are needed. Second, there was a lack of prospective analysis, and the sample size was small(TH is common, but cases cases whose EVD cannot be removed after TH are relatively rare). Third, the ETV and VPS cases were evaluated retrospectively on the basis of clinical records, and the postoperative follow-up was only 1 year; thus, this study lacked long-term follow-up. In addition, and the study design had certain errors and limitations, which need to be further improved in subsequent studies.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eETV have good efficacy in treating hydrocephalus caused by TH and TH breaking into the lateral ventricle and the third ventricle. However, if hydrocephalus is caused by TH with the fourth ventricular hematoma, VPS is a better surgical method because the recurrence rate of hydrocephalus in ETV is higher than that in VPS. Therefore, the choice of surgical method should be based on the patient\u0026rsquo;s clinical manifestations and hematoma type.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eVPS: ventriculoperitoneal shunt; ETV: endoscopic third ventriculostomy; TH: thalamic hemorrhage; EVD: external ventricular drainage; HICH: hypertensive intracerebral hemorrhage; CSF: cerebrospinal fluid; CT: computed tomography.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThe institutional review board at People\u0026rsquo;s Hospital of Ningxia Hui Autonomous Region Hospital approved the study. This research conforms with the Declaration of Helsinki. Data in this study will be made available on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThere is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThis study has received no financial support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eWC. L.: Data collection and statistical analysis, wrote the main manuscript. AD.D.: Data collection and revision of the manuscript. XM.Z.:Design of the study; confirmed the results of the statistical analysis.\u003c/p\u003e\n\u003cp\u003eThe authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eThe authors thank the nurses for providing useful advice and cooperation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTaek Min Nam, Ji Hwan Jang, Seung Hwan Kim, Kyu Hong Kim, Young Zoon Kim comparative analysis of the patients with spontaneous thalamic hemorrhage with concurrent intraventricular hemorrhage and those without intraventricular hemorrhage.[J] J Korean Med Sci. 2021; 36(1):e4.\u003c/li\u003e\n\u003cli\u003eLee SH, Park KJ, Kang SH, Jung YG, Park JY, Park DH. Prognostic factors of clinical outcomes in patients with spontaneous thalamic hemorrhage. Med Sci Monit. 2015; 21:2638-2646.\u003c/li\u003e\n\u003cli\u003eBrandon L. Neisewander Location of Thalamic Hemorrhage Impacts Prognosis.[J] World neurosurgery 2018;116: e525-e533. \u003c/li\u003e\n\u003cli\u003eMei Li, Fengqun Mu, Qian Han, Dongpo Su, Zhenzhong Guo, Tong Chen Intraventricular fibrinolytic for the treatment of intraventricular hemorrhage: a network meta-analysis.[J] Brain Inj 2020; 34(7):864-870\u003c/li\u003e\n\u003cli\u003eVogel TW, Bahuleyan B, Robinson S, Cohen AR. The role of endoscopic third ventriculostomy in the treatment of hydrocephalus. [J] J Neurosurg Pediatr. 2013; 12(1):54-61\u003c/li\u003e\n\u003cli\u003eFukuhara T, Shimizu T, Namba Y. Limited efficacy of endoscopic third ventriculostomy for hydrocephalus following aneurysmal subarachnoid hemorrhage. [J]Neurol Med Chir (Tokyo). 2009;49(10):449-55.\u003c/li\u003e\n\u003cli\u003eHailong F, Guangfu H, Haibin T, Hong P, Yong C, Weidong L, Dongdong Z. Endoscopic third ventriculostomy in the management of communicating hydrocephalus: a preliminary study.[J]J Neurosurg. 2008;109(5):923-30\u003c/li\u003e\n\u003cli\u003eRangel-Castilla L, Barber S, Zhang YJ.The role of endoscopic third ventriculostomy in the treatment of communicating hydrocephalus.[J]World Neurosurg. 2012;77(3-4):555-60.\u003c/li\u003e\n\u003cli\u003eHolly E Hinson, Daniel F Hanley, Wendy C Ziai Management of intraventricular hemorrhage. Curr Neurol Neurosci Rep. 2010; 10(2):73-82\u003c/li\u003e\n\u003cli\u003eZacharia BE, Vaughan KA, Hickman ZL, et al. Predictors of long-term shuntdependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion. Neurosurg Focus. 2012; 32(4):E5. \u003c/li\u003e\n\u003cli\u003eKuo L-T, Lu H-Y, Tsai J-C, Tu Y-K. Prediction of shunt dependency after intracerebral hemorrhage and intraventricular hemorrhage. Neurocrit Care. 2018; 29(2):233-240.\u003c/li\u003e\n\u003cli\u003ePaul Wrigh, Deborah R. Horowitz Clinical Improvement Related to Thrombolysis of Third Ventricular Blood Clot in a Patient With Thalamic Hemorrhage.[J] Journal of Stroke and Cerebrovascular Diseases 2001; 10(1):23-26.\u003c/li\u003e\n\u003cli\u003eGreenberg M. Handbook of Neurosurgery. 8th. New York: Thieme Medical Publisher; 2016.\u003c/li\u003e\n\u003cli\u003eRiegel T, Hellwig D, Bauer BL, Mennel HD Endoscopic anatomy of the third ventricle. Acta Neurochir Suppl. 1994;61:54-6.\u003c/li\u003e\n\u003cli\u003eK. Abhari, S. de Ribaupierre, T. Peters, R. Eagleson, Evaluation of a VR and stereoendoscopic tool to facilitate 3rd ventriculostomy, Stud. Health technol. Inform.2011;1631\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eA. Amini, R.H. Schmidt, Endoscopic third ventriculostomy in a series of 36 adult patients, Neurosurg. Focus. 2005;19 (6): E9.\u003c/li\u003e\n\u003cli\u003eN.K. Venkataramana, S.A. Rao, A.L. Naik, Endoscopic third ventriculostomy, J. Pediatr. Neurosci. 2009; 4 (2): 108\u0026ndash;112.\u003c/li\u003e\n\u003cli\u003eM.L. Walker, History of ventriculostomy, Neurosurg. Clin. N. Am. 2001;12(1): 101\u0026ndash;110.\u003c/li\u003e\n\u003cli\u003eGan gemiM．Dotmti P，Maiuri F，et a1．Endoscopicthird ventriculostomy for hydrocephalus．Minim lnvasive Neurosurg．1999;42: l28-l32．\u003c/li\u003e\n\u003cli\u003eHussein A Zeineddine, Antonio Dono, Ryan Kitagawa, Sean I Savitz, Huimahn Alex Choi, et al. Endoscopic Third Ventriculostomy for Hydrocephalus Secondary to Extraventricular Obstruction in Thalamic Hemorrhage:A Case Series.[J] Oper Neurosurg (Hagerstown). 2020; 19(4):384-392.\u003c/li\u003e\n\u003cli\u003eS. Obaid, A.G. Weil, R. Rahme, M.W. Bojanowski, Endoscopic third ventriculostomy for obstructive hydrocephalus due to intraventricular hemorrhage, J. Neurol. Surg. A Cent. Eur. Neurosurg. 2015; 76 (2):99\u0026ndash;111.\u003c/li\u003e\n\u003cli\u003eD. Bouramas, N. Paidakakos, F. Sotiriou, K. Kouzounias, M. Sklavounou, N. Gekas,Endoscopic third ventriculostomy in obstructive hydrocephalus: surgical technique and pitfalls, Acta Neurochir. Suppl. 2012;113:135\u0026ndash;139.\u003c/li\u003e\n\u003cli\u003eJ.E. Carter, K.N. Mizell, T.N. Evans, Neisseria sicca meningitis following intracranial hemorrhage and ventriculostomy tube placement, Clin. Neurol. Neurosurg. 2007;109 (10): 918\u0026ndash;921.\u003c/li\u003e\n\u003cli\u003eV. Siomin, G. Cinalli, A. Grotenhuis, A. Golash, S. Oi, K. Kothbauer, H. Weiner, J. Roth, L. Beni-Adani, A. Pierre-Kahn, Y. Takahashi, C. Mallucci, R. Abbott, J. Wisoff, S. Constantini, Endoscopic third ventriculostomy in patients with cerebrospinal fluid infection and/or hemorrhage, J. Neurosurg. 2002; 97 (3):519\u0026ndash;524.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":" \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eComparison of general clinical data between the two groups\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eETV(n\u0026thinsp;=\u0026thinsp;42)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eVPS(n\u0026thinsp;=\u0026thinsp;45)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eP value\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eGender\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.000\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e28\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e14\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e15\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAge (y)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e52.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e54.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.107\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePrevious disease:\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.983\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHypertension (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e34(80.9%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e40(88.9%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHeart disease (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e18(42.9%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e20(44.4%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDiabetes (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e19(45.2%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e21(46.7%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTH (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e16\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e15\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.612\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTH break into the ventricles (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.799\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLateral ventricle and third ventricle\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e26\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFourth ventricles\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e11\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eOperation times (min)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e35.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e82.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.001\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIntraoperative blood loss (ml)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e57.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e60.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.007\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHospital stay (d)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e14.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e13.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.391\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eVPS: ventriculoperitoneal shunt; ETV: endoscopic third ventriculostomy; TH: thalamic hemorrhage.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eComparison of postoperative complications between the two groups\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eETV(n,%)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eVPS(n,%)\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBleeding at the operation site\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1(2.4)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1(2.2)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFever\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e2(4.8)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1(2.2)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePneumocephalus\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e10(23.8)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e8(17.8)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIntracranial hypotension\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0(0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2(4.4)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eVPS: ventriculoperitoneal shunt; ETV: endoscopic third ventriculostomy.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eComparison of the reoperation rate between the two groups after 1 year of follow-up\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eETV(n,%)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eVPS(n,%)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eP value\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTH\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1(2.4)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1(2.2)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.961\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTH break into the ventricles (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLateral ventricle and third ventricle\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0(0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1(2.2)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.331\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFourth ventricle\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e6(14.3)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1(2.2)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.039\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eVPS: ventriculoperitoneal shunt; ETV: endoscopic third ventriculostomy; TH: thalamic hemorrhage.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Thalamic hemorrhage, Hydrocephalus, Ventriculoperitoneal shunt, Endoscopic third ventriculostomy, External ventricular drains","lastPublishedDoi":"10.21203/rs.3.rs-3834029/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3834029/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThis study aimed to compare the efficacy of ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) in the treatment of hydrocephalus after thalamic hemorrhage to provide reasonable surgical treatment.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe clinical data of 87 patients with hydrocephalus after TH whose external ventricular drainage(EVD) cannot be removed after hematoma absorption were retrospectively analyzed. The patients were divided into the VPS and ETV groups according to the different surgical methods. The operative time, length of hospital stay, complications, and reoperation rates of the two groups were compared.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere was no statistically significant difference in intraoperative bleeding and length of hospital stay between the two groups, and all patients had the EVD tube successfully removed after surgery. There were 4 (9.5%) complications in the ETV group and 3 (6.7%) complications in the VPS group, with no significant differences in postoperative complications between the two groups.During the 1-year follow up,7 patients (16.7%) in the ETV group and 3 patients (6.7%) in the VPS group required reoperation. There was a significant difference in the reoperation rates between the two groups. In the subgroup analysis of TH with fourth ventricular hemorrhage, 6 patients (14.3%) required reoperation in the ETV group, and 1 patient (2.2%) required reoperation in the VPS group; the difference between the two groups was statistically significant.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eETV have good efficacy in treating hydrocephalus caused by TH and TH breaking into the lateral ventricle and the third ventricle. However, if hydrocephalus is caused by TH with the fourth ventricular hematoma, VPS is a better surgical method because the recurrence rate of hydrocephalus in ETV is higher than that in VPS. 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