Endoport-Assisted Endoscopic Technique for Evacuating Severe Intraventricular Hemorrhage with Cast Third Ventricle Hematoma in an Underwater Field: A Technical Note.

Objective: We describe a 2-stage strategy utilizing the endoport-assisted endoscopic technique for the evacuation of severe intraventricular hemorrhage (IVH) with a cast third ventricle, and discuss potential pitfalls in the implementation of this method in clinical practice.

Methods: Patients with severe IVH (Graeb score >6) and a cast third ventricle who presented to our center from 2021 to 2023 were treated with a 2-stage surgical strategy utilizing the endoport-assisted endoscopic technique.

Results: A total of 9 patients with mean age of 55 years were included in the study. The preoperative mean Graeb score was 9, and postoperative mean Graeb score was 3, with a 72% evacuation rate for the entire ventricles. The median duration for external ventricular drainage was observed to be 6 days. In terms of 90-day modified Rankin Scale (mRS) scores, a favorable outcome (mRS 1-3) was demonstrated in 78% of the patients, while the remaining 22% presented with a poor outcome (mRS 4-6). There were no complications related to the surgery itself in any of the reported cases.

Conclusions: The endoport-assisted 2-stage endoscopic technique marks a significant advancement in treating severe IVH with a cast third ventricle. By combining dry and underwater approaches, it provides an innovative solution for effectively and safely clearing hematomas in both lateral and third ventricles. This technique addresses the crucial need for early cerebrospinal fluid circulation restoration, potentially improving outcomes for patients with these complex cases.