Technical considerations of neuroendoscopic management of obstructive hydrocephalus secondary to intraventricular hemorrhage.

Background: Intraventricular hemorrhage (IVH) is a critical neurosurgical condition frequently complicated by acute obstructive hydrocephalus, requiring urgent intervention. While external ventricular drainage remains the classic and widely accessible treatment, neuroendoscopic techniques have emerged as a minimally invasive option that allows direct resolution of cerebrospinal fluid (CSF) flow obstruction and, when indicated, hematoma evacuation. However, the literature provides limited technical guidance on neuroendoscopic management, particularly in settings with limited experience in this approach. Methods: We conducted a retrospective technical analysis of 12 patients with obstructive hydrocephalus secondary to IVH who underwent endoscopic third ventriculostomy (ETV), with or without hematoma evacuation. The study focuses on describing key procedural aspects, including intraventricular navigation strategies, relevant anatomical landmarks, and intraoperative decision-making processes. Results: The neuroendoscopic procedure was successfully completed in all 12 cases without any technique-related complications. Hematoma evacuation was performed when necessary, and CSF flow obstruction was effectively addressed in each case. Conclusion: This report provides a detailed technical description of ETV for the management of IVH-associated obstructive hydrocephalus. It emphasizes practical considerations aimed at supporting the safe implementation of neuroendoscopy in this context, particularly for centers with limited prior experience. The objective is not to conduct a comparative analysis or draw clinical outcome conclusions.