• Jennifer Jaffe, Eric Melnychuk, John Muschelli, Wendy Ziai, Timothy Morgan, Daniel F Hanley, and Issam A Awad.
• University of Chicago Pritzker School of Medicine, Section of Neurosurgery, Chicago, Illinois 60637, USA.
• Neurosurgery. 2012 May 1;70(5):1258-63; discussion 1263-4.

BackgroundThere is no consensus regarding optimal position of an external ventricular drain (EVD) with regard to clearance of intraventricular hemorrhage (IVH).ObjectiveTo assess the hypothesis that EVD laterality may influence the clearance of blood from the ventricular system with and without administration of thrombolytic agent.MethodsThe EVD location was assessed in 100 patients in 2 Clot Lysis Evaluating Accelerated Resolution of Intraventricular Hemorrhage (CLEAR IVH) phase II trials assessing the safety and dose optimization of thrombolysis through the EVD to accelerate the clearance of obstructive IVH. Laterality of catheter was correlated with clearance rates.ResultsClearance of IVH over the first 3 days was significantly greater when thrombolytic compared with placebo was administered regardless of catheter laterality (P < .005; 95% confidence interval, -14.0 to -4.14 for contralateral EVD and -24.7 to -5.44 for ipsilateral EVD). When thrombolytic was administered, there was a trend toward more rapid clearance of total IVH through an EVD placed on the side of dominant intraventricular blood compared with an EVD on the side with less blood (P = .09; 95% confidence interval, -9.62 to 0.69). This was not true when placebo was administered. Clearance of third and fourth ventricular blood was unrelated to EVD laterality.ConclusionIt is possible that placement of EVD may be optimized to enhance the clearance of total IVH if lytic agents are used. Catheters on either side can clear the third and fourth ventricles with equal efficiency.

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