Endoscopic Intraventricular Hematoma Evacuation Surgery Versus EVD for IVH
Endoscopic Intraventricular Hematoma Evacuation Surgery Versus EVD for IVH
Intraventricular hemorrhage (IVH) accounts for about 20% of intracerebral hemorrhage, but its
 mortality rate is as high as 50%-80%. External ventricular drainage (EVD) can rapidly reduce
 intracranial pressure, but clinical practice found that drainage catheters are often blocked
 by blood clots and long-term thrombolytic therapy is likely to cause secondary bleeding. The
 application of neuroendoscopy in IVH has attracted more and more attention in recent years.
 Studies have shown that the use of neuroendoscopy for IVH evacuation (with EVD) has
 advantages over EVD alone. However, the cases of most current research are small and all of
 them are retrospective studies, which means lacking prospective clinical studies to provide
 high-quality evidence. Based on this, we intend to conduct a randomized, controlled,
 multi-center clinical trial to compare the prognosis of patients who undergo endoscopic IVH
 evacuation surgery versus those who undergo external ventricular drainage for moderate to
 severe IVH.
Spontaneous Intraventricular hemorrhage (IVH) is defined as bleeding into the cerebral
 ventricular system caused by spontaneous rupture of brain arteries, veins and capillaries
 instead of trauma. IVH accounts for about 20% of cerebral hemorrhage, but its mortality rate
 is as high as 50%-80%. According to the results of the STICH trial, the prognosis of patients
 with IVH is worse than that of patients without IVH (p<0.00001); if patients with IVH have
 hydrocephalus, the prognosis is the worst.

 According to the edition of 2015 Chinese multidisciplinary experts' consensus for spontaneous
 cerebral hemorrhage diagnosis and treatment and 2015 AHA/ASA spontaneous cerebral hemorrhage
 diagnosis and treatment guidelines, for patients with small amount of IVH without obstructive
 hydrocephalus, conservative treatment or continuous lumbar drainage can be effective. For
 patients with large amount of IVH (hematoma occupying more than 50% of the lateral ventricle,
 secondary obstructive hydrocephalus or obviously increased intracranial pressure), the
 occupancy effect is dramatic and patients are prone to suffering from hydrocephalus and
 cerebral palsy, in which circumstances urgent evacuation of hematoma is required, but it is
 controversial whether it is beneficial for the patients and whether it can improve the
 prognosis of patients.

 As the regular treatment for IVH, external ventricular drainage (EVD) can rapidly reduce
 intracranial pressure, but clinical practice found that drainage catheters are often blocked
 by blood clots, and long-term thrombolytic therapy is likely to cause secondary bleeding.
 Usually, the catheters need to be removed or replaced one week after placement as for the
 increasing risk of infection.

 The application of endoscopy in IVH has attracted more and more attention. Studies have shown
 that the use of endoscopy for IVH evacuation (with EVD) has advantages over EVD alone. The
 incidence of postoperative hydrocephalus and the need for ventricular-peritoneal shunt
 surgery is lower. However, the cases of most current research are small and all of them are
 retrospective studies. There are no such clinical trials registered at home and abroad, and
 that is, there is a lack of prospective high-quality clinical studies to further demonstrate
 the effect of endoscopic treatment for IVH.

 Based on this, we intend to conduct a randomized, controlled, multi-center clinical trial to
 compare the prognosis of patients who undergo endoscopic IVH evacuation surgery versus those
 who undergo external ventricular drainage for moderate to severe IVH.
Inclusion Criteria:

 -  1. Age ranging from 18 to 70 years old; 2. Imaging examination shows deep brain
 hemorrhage breaking into the ventricles or primary intraventricular hemorrhage, and
 the amount of bleeding is large, more than 50% of the lateral ventricle or complete
 ventricle cast; 3. Graeb score > 4 points; 4. Voluntary signing of informed consent;

 Exclusion Criteria:

 -  1. Patients with a history of chronic obstructive pulmonary disease, coronary heart
 disease, chronic kidney disease, blood disorders, cancer, systemic autoimmune disease,
 or long-term oral corticosteroids; 2. Imaging examination shows cerebellum and brain
 stem hemorrhage; 3. Detected cerebrovascular diseases in CTA/MRA/MRV/DSA examinations
 (choose 1 or 2 examinations); 4. Ultra-early (within 72 hours) or late enhanced MRI
 suggests the presence of brain tumors; 5. Coagulopathy or long-term oral
 anticoagulant;