Technical Note

Free Hand Aspiration for Large
Periventricular Hemorrhage:
CASE REPORT
Shigeki Imaizumi, M.D., Takehide Onuma, M.D., Masaki Mino, M.D.,
Motonobu Kameyama, M.D., and Osamu Motohashi, M.D.
Department of Neurosurgery, Sendai City Hospital, Sendai, Japan

Imaizumi S, Onuma T, Mino M, Kameyama M, Motohashi O. Free
hand aspiration for large periventricular hemorrhage: case report. Surg Neurol 2001;55:376 –7.
BACKGROUND

At present, there are several therapeutic options, including craniotomy and stereotactic aspiration, for large intracerebral hemorrhage perforating into the lateral
ventricle. In the cases with Glasgow Coma Scale (GCS)
scores under 6 with anisocoria, external ventricular
drainage would be the first choice [2– 4]. We have also
performed anterior ventricular horn puncture in a standard manner. The target was the foramen of Monro,
at a depth of 5.5 cm from the inner table of the skull.
The point of insertion was located just anterior to the
coronal suture, approximately 10 cm above the nasion,
and 3 cm from the midline [1]. However, we noticed that
the insertion of a catheter into the periventricular hematoma adjacent to the lateral ventricle was made easier
by tilting the catheter 30° laterally as in the first case
(Figure 1).
METHODS

In our method, inclining the catheter by 30° laterally, we
used a silicone tube 3.5 mm in internal diameter (Silascon® ventricle drainage tube, Kaneka Medix Corp.,
Osaka, Japan) and then replaced it with another Silascon® tube with a 2.5 mm-internal diameter. From January
1999 through December 2000, eleven patients who all had
GCS scores under 6 and anisocoria preoperatively were
treated by this method. The series included two patients
who were undergoing hemodialysis because of renal failure, two with bleeding tendency because of liver dysfunction, and one with heart failure.

Address reprint requests to: Dr. Shigeki Imaizumi, Department of Neurosurgery, Sendai City Hospital, 3-1 Shimizukoji, Wakabayashiku, Sendai,
984-8501, Japan.
Received October 3, 2000; accepted February 6, 2001.

0090-3019/01/$–see front matter
PII S0090-3019(01)00466-9

RESULTS

The insertion itself caused no complications. Cerebrospinal fluid was drained smoothly after removal of hematoma because the hematoma cavity connecting with the
lateral ventricle was opened. Two typical cases using this
technique are shown (Figures 1 and 2). All patients recovered favorable consciousness postoperatively compared with the preoperative state but hemiparesis remained. Postsurgical follow up at 3 months revealed the
outcomes evaluated by Glasgow Outcome Scale (GOS)
were moderate disability in 5 patients and severe disability in 6 patients.
CONCLUSION

This direct aspiration and drainage of a large intracerebral hematoma that ruptures into the lateral ventricle is
superior to simple ventricular drainage in regard to the
removal of the hematoma clot. This technique would be
the choice especially in patients with serious complications such as cardiac disease and renal failure. © 2001
by Elsevier Science Inc.
KEY WORDS

Periventricular intracerebral hematoma, aspiration, ventricular drainage.

REFERENCES
1. Ghajar JBG. A guide for ventricular catheter placement. J Neurosurg 1985;63:985– 6.
2. Khanna RK, Rosenblum ML, Rock JP, Malik GM. Prolonged external ventricular drainage with percutaneous long-tunnel ventriculostomies. J Neurosurg 1995;
83:791– 4.
3. O’Leary ST, Kole MK, Hoover DA, Hysell SE, Thomas
A, Shaffrey CI. Efficacy of the Ghajar guide revisited: a
prospective study. J Neurosurg 2000;92:801–3.
4. Schaller C, Meyer B, Rohde V, Hassler W. Emergency
ventriculostomy— experience with a new screw device. technical note. Neurosurgery 1994;35:982–5.

© 2001 by Elsevier Science Inc.
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Drainage of Large Periventricular Hematoma

Surg Neurol 377
2001;55:376 –7

CT images demonstrating sequential changes in a 58-year-old female. Left: Preoperative image showing left putaminal
hemorrhage perforating into the lateral ventricle. Middle: Postoperative image obtained 2 days later, revealing
reduction of hematoma. Right: Repeated CT image obtained 1 month later showing a favorable evacuation of the hematoma.

1

CT images demonstrating sequential changes in a 72-year-old female. Left: CT image on admission showing right
putaminal hemorrhage perforating into the lateral ventricle. Middle: Repeated CT image obtained just after
operation. Right: CT image 1 month later showing a favorable evacuation.

2