Turkish Neurosurgery
Felipe Soares Bolentine1, Elany Maria Ferreira Portela1, Iara Santos Rodrigues1, Laryssa Maria Ribeiro Araújo1, Anderson Eduardo Anadinho da Silva1, Leonardo Zumerkorn Pipek2, Josué da Silva Brito3, Eberval Gadelha Figueiredo4, Nicollas Nunes Rabelo5
1UniAtenas, Internal Medicine, Paracatu-MG,
2University of São Paulo, Neurology, São Paulo-SP,
3Atenas Medical School, Internal Medicine, Passos-MG,
4University of São Paulo, Neurosurgery, São Paulo-SP,
5Atenas Medical School, Neurosurgery, Passos-MG,
DOI: 10.5137/1019-5149.JTN.45919-23.1

Introduction: Extraventricular drainage (EVD) combined with fibrinolytics may prove effective in reducing morbidity and mortality rates associated with intraventricular cerebral hemorrhage (IVH). This efficacy is primarily attributed to increased drainage capacity and a decreased risk of EVD obstruction when fibrinolytics are employed. This systematic review and meta-analysis aimed to determine the effectiveness of thrombolytics in this context. Methods: A literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO registration number: CRD42022332152). Articles were selected from various sources, including PubMed, Trip Database, LILACS, Cochrane Library, and ScienceDirect. Clinical trials focusing on IVH treatment using EVD and/or fibrinolytics were considered. The Risk of Bias in Non-randomized Studies of Interventions (ROB 2) tool was employed for bias assessment. A fixed-effects regression model was used following heterogeneity analysis. Treatment effectiveness was evaluated based on mortality outcomes. Results: A total of 531 patients from four studies were included. The use of fibrinolytics significantly decreased IVH mortality compared with a placebo. The odds ratio (OR) for recombinant tissue plasminogen activator (rtPA) or alteplase was 0.54 [0.36; 0.82]. For urokinase (UK), the OR was 0.21 [0.03; 1.54], rendering it statistically non-significant. The overall OR was 0.52 [0.35; 0.78], and the heterogeneity I2 was 0% (indicating low heterogeneity). Conclusion: While EVD alone is a common approach for managing hydrocephalus, its effectiveness is limited by potential blockages and infections. Combining EVD with UK or rtPA demonstrated improved patient outcomes. rtPA stands out as a reliable and effective option, while limited data are available regarding UK\'s effectiveness in reducing IVH mortality.

Corresponding author : Felipe Soares Bolentine