الفهرس 
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Abstract
During the past decade, there has been a considerable and increasing interest in the medical and surgical management of massive IVHs.
Excluding the posttraumatic causes, the etiology of IVH is as follows, in order of decreasing frequency: aneurysmal rupture (33.3 %), spontaneous hypertensive hematoma 25.5 % idiopathic (23.5 %), ruptured arteriovenous malformation (AVM; 9.8 %), hypocoagulative state (5.9 %), and brain metastases (1.9 %).
There are four mechanisms involved in IVH pathophysiology: obstructive hydrocephalus, the mass effect exerted by the blood clot, the toxicity of blood-breaking products on the adjacent brain parenchyma, and the development of chronic hydrocephalus. Even with the best medical management, mortality rates have been reported to be as high as 50%.
The IVH,Graeb, and LeRoux scores were developed to estimate IVH severity based on gross hemorrhage size and the presence of dilation within each ventricle. The scores are useful for IVH evaluation at admission and have been used to define IVH severity.
The prognosis of IVH is affected by several factors, including age, sex, GCS score, presence of acute hydrocephalus, coagulopathy, origin of the bleeding, and tetraventricular inundation. These factors all play a critical role, but in the first hours after IVH, the sudden increase in ICP associated with initial bleeding may cause a significant reduction in cerebral blood flow, potentially leading to ischemia.
The initial management of IVH has included the placement of 1 EVD or more to allow the egress of blood and CSF from the ventricle system and decrease ICP. However, this approach alone is often not sufficiently effective in improving the poor prognosis of patients with severe IVH. Patency of the EVD is frequently difficult to maintain due to occlusion of the catheter by coagulated blood.
Neuroendoscopic approaches have been reported to produce positive outcomes in patients with IVH In all cases; efficient removal of intraventricular clots was rapidly achieved. The use of a flexible instrument and the freehand technique, albeit offering a narrower operating channel, allows more complete cleansing of the third ventricle and navigation down to the fourth ventricle through the aqueduct. Persistence of blood in the fourth ventricle is related to poor outcomes in patients with IVH.
The study was done prospectively in the Neurosurgery Department, Alexandria Main Hospital, Alexandria University. The cases admitted in the period between March 2014and March 2015, suffering from spontaneous intraventricular hemorrhage. The study was carried out to identify the benefit of usage of neuroendoscope followed by external ventricular drainage in cases of IVH as a treatment for intraventricular hemorrhage. Patients selected for this study were from 47-70 years old, Glasgow coma scale 4 or more. CT scan of the brain was the main diagnostic test used, to verify presence of IVH and associated hydrocephalus. Patients were subjected to endoscopic evacuation of the hematoma followed by external ventricular drainage until CSF become clear.Serial CT brain of at least 2-3 times after the surgery was normally done to detect hydrocephalus. All cases were admitted to the intensive care unit. Cases were operated upon within a period of 48 hours of presentation. All patients were evaluated postoperatively by a CT scan of the brain on the second postoperative day. The most common and important associated conditions; hypertension, and anticoagulant drugs were evaluated as regards association with the development of the hematoma and the effect on outcome. The outcome of the operated patients was evaluated as regards; residual hematoma, mortality and mortality.
Certain analytical studies were used to assess the role of endoscopic evacuation of spontaneous intraventricular hemorrhage in terms of :Success of hemorrhage evacuation,Control of bleeding, management of hydrocephalic changes,Clinical outcome.
We concluded that the endoscopic evacuation of intraventricular hemorrhage is a safe and effective method, regarding reversal of hydrocephalus, removal of most of intraventricular blood and rate of complications. Improvement in outcome post operatively depends primarily on pre operative Glasgow coma scale rather than on amount of blood evacuated.