Emergency neuroendoscopic evacuation of traumatic intraventricular hemorrhage: A case report

Background: Traumatic intraventricular hemorrhage (tIVH) is an uncommon but severe manifestation of traumatic brain injury and is associated with poor neurological outcomes, particularly when accompanied by acute hydrocephalus. While neuroendoscopic hematoma evacuation has been reported to be effective for intraventricular hemorrhage (IVH) secondary to spontaneous intracerebral hemorrhage, its role in tIVH remains unclear. We report a rare case of rapidly progressive tIVH complicated by acute hydrocephalus, successfully treated with emergency endoscopic hematoma evacuation. Notably, the bleeding source was directly visualized endoscopically, providing important insights into the underlying pathophysiology of tIVH. Case Description: An 81-year-old woman presented with mild consciousness disturbance after a fall. Initial head computed tomography (CT) demonstrated a small IVH in the right lateral ventricle. Despite conservative management, follow-up CT revealed rapid progression of cast-like IVH extending into the third and fourth ventricles, accompanied by acute hydrocephalus. Emergency neuroendoscopic hematoma evacuation was performed. During surgery, active venous bleeding was directly visualized on the lateral wall of the right lateral ventricle and successfully controlled by coagulation. Endoscopic third ventriculostomy was also performed. Postoperative imaging confirmed adequate hematoma removal without rebleeding. Although delayed hydrocephalus required ventriculoperitoneal shunt placement, no vascular abnormalities were identified on postoperative CT angiography. Conclusion: Emergency neuroendoscopic hematoma evacuation for tIVH enabled rapid decompression, direct identification of the bleeding source, and effective hemostasis. This case suggests that endoscopic surgery may be a useful therapeutic option in selected patients with rapidly progressive tIVH and acute hydrocephalus. Further accumulation of cases is required to clarify its impact on long-term neurological outcomes.