External ventricular drainage for spontaneous intracerebral hemorrhage with intraventricular hemorrhage: mortality and outcomes in Mali

Abstract

Introduction: Intracerebral hemorrhage (ICH) with intraventricular hemorrhage (IVH) is a serious condition associated with high morbidity and mortality. External ventricular drainage (EVD) is a major tool in the treatment of IVH to manage elevated intracranial pressure and may reduce short-term mortality.

The aim of this study was to determine the impact of EVD placement in the acute phase on mortality and short-term neurologic outcomes in patients with spontaneous ICH associated with IVH.

Materials and methods: We conducted a prospective observational study including adult patients admitted to Gabriel Toure University Hospital over a five year period between January 2019 and December 2023. Demographic, clinical and radiographic characteristics of patients were recorded. All patients who underwent EVD for primary diagnosis of ICH and radiographic evidence of IVH were included. The Graeb score was used to assess the severity of IVH. Outcomes were evaluated using the Glasgow Coma Scale (GCS) and the modified Rankin score (mRS). Statistical analysis was performed to determine independent predictor factors of 30-day mortality using Wilcoxon rank sum test and Fisher’s exact test. P value ≤ 0.05 was considered statistically significant.

Results: During the study period, a total of 63 patients were admitted for spontaneous ICH and IVH was associated in 24 (38.1%) patients. Among them, EVDs were placed in 17 patients. The mean age was 49 years with range of 27 to 66 years. There were 11 males and 6 females. The main risk factors of stroke were hypertension in 13 patients and diabetes in 7 patients. The initial GCS ranged from 5 and 8. Unilateral pupillary dilatation was found in 8 patients. The duration of EVD ranged from 1 to 8 days. The short term mortality rate was 70.5 % at 30 days. The functional outcomes were poor in 4 patients with mRS score of 4 and 5. The independent predictor factors for 30-day mortality were poor GCS (p=0.319), Mydriasis (p=0.245) and poor Graeb score (p=0.004).

Conclusion: The placement of EVD in patient with IVH remains controversial. Our study reveals the high mortality rate in patients with ICH despite this procedure, raising questions about the usefulness of this procedure in our setting. Although our study demonstrated a high mortality rate, patients with appropriate indications undoubtedly require EVD. Complementary and randomized studies are necessary in the future.