# Comparative Short-Term Outcomes of Conservative Management Versus External Ventricular Drainage in Adults With Spontaneous Intraventricular Hemorrhage: A Mixed Observational Cohort Study

## TL;DR

This study compares conservative treatment and surgery for spontaneous brain bleeding and finds that conservative care leads to better short-term recovery and survival.

## Contribution

The study provides new evidence on the effectiveness of conservative management over surgery for spontaneous intraventricular hemorrhage in adults.

## Key findings

- Conservative treatment showed a higher improvement rate (90% vs. 60%) compared to surgery.
- Conservative treatment had lower mortality (10% vs. 40%) than surgical intervention.
- Surgical patients experienced more frequent hemiparesis (85% vs. 55%).

## Abstract

Background: Spontaneous intraventricular hemorrhage (IVH) is a rare and serious condition with high morbidity and mortality, often leading to hydrocephalus and elevated intracranial pressure. Optimal management, surgical versus conservative, remains a topic of debate, particularly when hydrocephalus is present.

Objective: This study aimed to compare clinical outcomes in adult patients with spontaneous IVH managed conservatively versus those undergoing external ventricular drainage (EVD).

Patients and methods: This single-center mixed retrospective-prospective observational study included 40 adult patients with spontaneous IVH managed either conservatively or with EVD. All patients underwent full clinical assessment, brain magnetic resonance imaging (MRI), and computed tomography (CT) angiography. Outcome was measured using Glasgow Coma Scale (GCS) changes at discharge. Comparisons between groups were conducted using chi-squared tests for categorical variables and t-tests or Mann-Whitney U tests for continuous variables.

Results: There were insignificant variances in sex, age, Graeb score, or follow-up CT findings between the two groups. However, hemiparesis was significantly more frequent in the surgical group (85% vs. 55%; P=0.038). Conservative treatment resulted in a significantly higher improvement rate (90% against 60%; P=0.028) and lower mortality (10% vs. 40%).

Conclusion: Conservative treatment in selected adult patients with spontaneous IVH was associated with better short-term outcomes in terms of functional recovery and survival compared to surgical interventions, which were associated with more neurological complications and higher mortality. However, these findings should be interpreted in light of baseline severity differences that may have influenced treatment selection.