Neuroendoscopic lavage versus external ventricular drainage in spontaneous intraventricular hemorrhage: A cohort-matched comparative study.

Introduction: Spontaneous intraventricular hemorrhage (IVH) has high mortality and poor functional outcome. External ventricular drainage (EVD) is standard treatment but is limited by catheter obstruction, infection, prolonged intensive care, and shunt-dependent hydrocephalus. We compared neuroendoscopic lavage (ENDO) with EVD alone in adults with spontaneous IVH. Research question: Does neuroendoscopic lavage offer advantages over external ventricular drainage alone in IVH management? Methods: This matched study included 46 adults with spontaneous IVH (23 ENDO + EVD; 23 EVD). Patients were matched 1:1 for age, admission Glasgow Coma Scale (GCS), and modified Graeb score (mGS). Outcomes were ventricular clot reduction, ICU stay, EVD duration, shunt dependency within 6 months, and modified Rankin Scale (mRS) at discharge and 90 days. Results: Baseline characteristics were comparable. Endoscopic lavage achieved a 66.7 % reduction in ventricular blood burden. Median EVD duration was significantly shorter after ENDO (3 vs. 7 days) as was ICU stay (8 vs. 25 days). Shunt placement was necessary in 13 % (ENDO) versus 26 % (EVD). Among shunted patients, time to VP shunt was shorter after ENDO (10.0 vs. 15.5 days). Functional outcome favored ENDO at discharge (median mRS 4 vs. 5) and at 90 days (median mRS 3 vs. 5). Ninety-day favorable outcome (mRS 0-3) was achieved in 52.1 % versus 13.1 %, respectively. Conclusion: Neuroendoscopic lavage in spontaneous IVH is associated with improved clot clearance, reduced ICU and drainage duration, lower shunt dependency, and superior early functional outcome compared with EVD alone. Prospective randomized trials are needed to confirm these findings.