• Mette Haldrup, Rares Miscov, Niwar Mohamad, Mads Rasmussen, Stig Dyrskog, Claus Ziegler Simonsen, Mads Grønhøj, Frantz Rom Poulsen, Carsten Reidies Bjarkam, Birgit Debrabant, and Anders Rosendal Korshøj.
• Department of Neurosurgery, Aarhus University Hospital, Aarhus N, Denmark. Electronic address: methalje@rm.dk.
• World Neurosurg. 2023 Jun 1; 174: 183196.e6183-196.e6.

BackgroundExternal ventricular drainage (EVD) is a key factor in the treatment of intraventricular hemorrhage (IVH) but associated with risks and complications. Intraventricular fibrinolysis (IVF) has been proposed to improve clinical outcome and reduce complications of EVD treatment. The following review and metaanalysis provides a comprehensive evaluation of IVH treatment with external ventricular drainage (EVD) and intraventricular fibrinolysis (IVF) with regards to complications and clinical outcomes.MethodsThe PRISMA guidelines were followed preparing this review. Studies included in the meta-analysis were compared using forest plots and the related odds ratios.ResultsAfter a literature search, 980 articles were identified and 65 and underwent full-text review. Forty-two articles were included in the review and meta-analysis. We found that bolted and antibiotic-coated catheters were superior to tunnelled/uncoated catheters (P < 0.001) and antibiotic- vs. silver-impregnated catheters (P < 0.001]) in preventing infection. Shunt dependency was related to the volume of blood in the ventricles but unaffected by IVF (P = 0.98). IVF promoted hematoma clearance, decreased mortality (22.4% vs. 40.9% with IVF vs. no IVF, respectively, P < 0.00001), improved good functional outcomes (47.2% [IVF] vs. 38.3% [no IVF], P = 0.03), and reduced the rate of catheter occlusion from 37.3% without IVF to 10.6% with IVF (P = 0.0003).ConclusionsWe present evidence and best practice recommendations for the treatment of IVH with EVD and intraventricular fibrinolysis. Our analysis further provides a comprehensive quantitative reference of the most relevant clinical endpoints for future studies on novel IVH technologies and treatments.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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