Intraventricular hemorrhage (IVH) usually refers to spontaneous, i.e., rupture of intracranial vessels under the action of non-traumatic factors, and blood breaks into the ventricular system. ivh is a common complication of cerebral hemorrhage and subarachnoid hemorrhage, and the incidence of cerebral hemorrhage complicated by ivh is 42%-52%, and the mortality rate of ivh is 50%-80%. The incidence of IVH in preterm infants with low body mass is reported to be 15%-20% and the mortality rate is 20%-50%, and because of the high mortality and disability rate of IVH and the poor efficacy of medical treatment, researchers have been exploring more ideal surgical treatments in recent years. PIVH refers to bleeding within 1.5 cm of the choroid plexus vessels and subventricular canal; SIVH refers to bleeding within 1.5 cm of the choroid plexus vessels and subventricular canal; SIVH refers to bleeding within 1.5 cm of the choroid plexus vessels and subventricular canal; SIVH refers to bleeding within 1.5 cm of the choroid plexus vessels and subventricular canal. The common causes of SIVH are hypertensive atherosclerosis, intracranial aneurysm, arteriovenous malformation, smog, etc. The common sites of hemorrhage in IVH are, in descending order, the nucleus accumbens (35% to 50%), the lobes of the brain (35% to 50%), and the brain. The common sites of hemorrhage in IVH are, in order, the nucleus accumbens (35% to 50%), lobes (30%), thalamus (10% to 15%), pons (5% to 12%), caudate nucleus (7%) and cerebellum (5%). The pathophysiological basis of IVH, which produces slow absorption of the hematoma and acute neurological deterioration, is complex and varied, including: when the hematoma blocks the interventricular foramen or the midbrain aqueduct and the ventricular system cast, the cerebrospinal fluid circulation pathway is blocked to form hydrocephalus; acute hydrocephalus and the compression of the ventricular hematoma lead to the enlargement of the ventricles, resulting in increased intracranial pressure and slow periventricular blood flow; Acute intracranial pressure elevation can cause brainstem compression and deformation leading to coma and death; the neurotoxic effect induced by thrombin in blood acts directly on brain parenchyma and produces damage; after IVH, blood enters the subarachnoid space, red blood cells rupture and decompose releasing catecholamines, 5-HT and other vasoactive substances, while producing a large number of free radicals and acidic metabolites thus causing brain tissue hypoxia and cerebral vascular spasm, resulting in further damage to brain tissue. Mohr et al. studied 9l cases of IVH due to intracranial aneurysm and concluded that the degree of ventricular dilation is closely related to the prognosis of IVH due to aneurysm, and concluded that ventricular dilation is the most important pathophysiological mechanism of IVH. III. Grading and scoring The currently used IVH scoring system is divided into two types: human IVH and infant IVH. Graeb score is commonly used for adult IVH. Some scholars have developed the modifiedGraebscore (MGS) method based on the original Graeb score. Papile’s score is often used in infants and children with IVH. The above scoring and grading methods are mainly used for the assessment of intracerebroventricular hemorrhage and the extent of hemorrhage on CT imaging, and then to assess the severity of IVH. Qureshi et al. reported that the thalamic hemorrhage broke into the ventricles and the hematoma stabilized after 309 min of bleeding. Ultra-early surgery (6-8 h after onset) has been affirmed by many scholars because it can remove the hematoma earlier, reduce cerebral edema, and promote neurological recovery, but its specific efficacy has yet to be further demonstrated. Within 24 h of hemorrhage, thrombin can be released during blood coagulation, resulting in edema in the adjacent brain tissue, disrupting the blood-brain barrier and producing cytotoxic effects. Therefore, the author believes that 6 to 24 h is the best time for surgical treatment. However, in reality, patients with critical condition, unstable vital signs, severe consciousness impairment or even brain herniation within 6h should be operated immediately; after more than 24h or even 72h, if the brain tissue edema is serious and more complications appear, it is still relevant to perform surgical treatment. V. Surgical treatment For IVH, surgical treatment should be performed as soon as possible. It is necessary to rapidly remove intracerebroventricular blood to reduce the occupying effect, shunt cerebrospinal fluid or improve cerebrospinal fluid circulation, reduce intracranial pressure and reduce neurological damage. Commonly used surgical treatment methods are as follows: 1, lateral ventricular puncture and drainage (externalventriculardrainage, EVD): This method is simple, easy to perform, safe and effective, and can significantly reduce the lethality rate, and is often used as an emergency measure for the treatment of IVH in clinical practice. The advantages of single (double) lateral ventricular drainage under local anesthesia are: it is less invasive; it can reduce hydrocephalus and control intracranial pressure by timely removal of intracerebroventricular or parenchymal hematoma and thus regulate cerebrospinal fluid circulation; it can avoid adverse effects such as renal impairment caused by excessive use of mannitol to reduce intracranial pressure and cerebral edema at an early stage. The disadvantages include incomplete removal of the hematoma, continuous extraventricular drainage, which may lead to poor cranial pressure lowering effect, and easy infection. It has been reported in the literature that failure to remove the clot attached to the ventricular wall may even induce Parkinson’s disease. 2.Craniotomy: This method has good field exposure and can rapidly remove the hematoma in a short period of time. In addition, cranial hematoma removal with adequate hemostasis can relieve cerebral edema and improve the cerebrospinal fluid circulation pathway, with good hypotensive effect. The indications for this method include: (1) large hematoma volume (supratentorial hematoma >40ml, subatentorial hematoma >10m1) on CT examination; (2) significant displacement of midline structures (displacement >1cm), significant compression of ventricles or brain pools; (3) progressive increase in the degree of impaired consciousness; (4) intracranial pressure monitoring showing a pressure of 2.67kPa (273mmH:O) or more, with a (5) signs of focal brain damage and a Glasgow Coma Scale (GCS) score >4. The disadvantages of this method are that it can lead to neurological damage, high incidence of secondary bleeding, large damage to brain tissue (especially deep brain tissue), and unsatisfactory efficacy. 3, stereotactic intracerebral hematoma removal: imaging technology and the development of stereotactic technology for stereotactic intracerebral hematoma removal to provide broad prospects for development. Its advantages are: (1) preoperative CT three-dimensional scanning, can accurately determine the site and scope of intracranial hematoma and calculate the amount of bleeding; (2) surgery is less invasive, according to the site of hematoma multi-directional multi-path puncture to avoid damage to nerves and blood vessels; (3) the method is suitable for the removal of deep brain hematoma and the elderly and frail can not tolerate craniotomy; (4) can promote the recovery of consciousness. The disadvantages include: low clearance rate of hematoma, difficulty in aspiration of coagulated clots, inability to avoid brain tissue damage caused by negative pressure during hematoma aspiration; can lead to secondary bleeding, and because the method is operated under non-direct vision, it cannot directly stop bleeding. 4.Neuroendoscopic hematoma removal: In the 1980s, neuroendoscopic techniques were pioneered by Auer and others in the treatment of neurosurgical diseases, which opened up a new way for the minimally invasive treatment of intracranial hematoma. The advantages of using neuroendoscopic techniques for the treatment of IVH are: minimal damage to brain tissue, which is a minimally invasive procedure; removal of intracranial hematoma in a short time, even to the third or fourth ventricle; flushing of bloody cerebrospinal fluid, which is often used for obstructive hydrocephalus complicated by IVH; and removal of hematoma under direct vision, which can stop bleeding intraoperatively, which can reduce the damage to the wall of the hematoma cavity to avoid new bleeding. However, the field of view is relatively small when using endoscopy, which is inconvenient to operate; in addition, there are many endoscopic accessories, which require high aseptic conditions during operation and are prone to postoperative infection. Currently, neuroendoscopic techniques are commonly used to perform endoscopic third ventriculostomy (endoscopicthirdventriculostomy, EVT). 5, the application of fibrinolytic drugs: fibrinolytic drugs are suitable for the presence of blood clots in the ventricular system, ventricular casts, blockage of extraventricular drains and other conditions that are not conducive to the drainage of bloody cerebrospinal fluid. Currently, the commonly used fibrinolytic drugs are urokinase and recombinant tissue-type fibrinogen activator (rt~PA). Fibrinolytic drugs injected through an extraventricular catheter are relatively safe for the treatment of IVH. In addition, this method can prevent blockage of extraventricular drains, accelerate the clearance of IVH hematoma, lysis of cast clots in the ventricular system, and restore normal neurological status, as well as improve cerebrospinal fluid circulation pathways and reduce intracranial pressure and lethality. In addition, it has been suggested that the application of fibrinolytic drugs is superior to the rate of clearance of lateral ventricular hematoma for the third and fourth ventricles. The general usage of fibrinolytic drugs is: (1) Urokinase: 10,000 IU/12h, 2ml saline flush, open after 1h of closed tube, the maximum daily dose is 20,000-40,000 IU. stop using when the Graeb score of CT examination is <6. (2) rt-PA: 2-5mg/dose, 2ml saline flush tube, open after 1h or 2h of closed tube, continue treatment until the hematoma of the third and fourth ventricles is cleared and the volume of the lateral ventricular hematoma is greatly reduced, depending on the situation. The main disadvantage of this method is that it is prone to rebleeding as well as easy to cause intracranial infection by reverse drug administration through the catheter. Cerebrospinal fluid replacement: The purpose of this method is to improve the cerebrospinal fluid circulation pathway, drain the blood accumulated in the ventricular system, especially in the third and fourth ventricles; eliminate the harmful effects of toxic substances released after the destruction of red blood cells; avoid the adhesion of red blood cells and blood clots, block the arachnoid granules, reduce the incidence of postoperative hydrocephalus; and reduce vasospasm. Currently, lumbar puncture and lumbar puncture tube drainage are commonly used for cerebrospinal fluid replacement. In addition, the Ommaya capsule device can be used to drain cerebrospinal fluid, with the following advantages: (1) the end of the catheter is inserted into the ventricle and the reservoir capsule is placed under the skin, reducing the chance of infection; (2) when the extraventricular drainage tube is removed, the capsule can be inserted through a fine needle to continue drainage or medication can be given. However, once the Ommaya bursa is blocked, it needs a second surgery to remove it, which is expensive. 7.Transcranial ultrasound therapy: Transcranial ultrasound thrombolytic therapy instrument is the first domestic and international advanced new special instrument, the ultrasonic energy of certain power and frequency can dissolve cerebral thrombus and increase the activity of fibrinolytic drugs. This therapy is mainly used in cerebrovascular diseases, other nerve pain and paralysis. In the treatment of IVH or cerebral hemorrhage, transcranial ultrasound therapy is mainly used in combination with fibrinolytic drugs to increase the activity of the drugs and accelerate the effect of clot dissolution. 8.Stem cell transplantation: Stem cell transplantation for IVH is an emerging treatment method, mainly used for the treatment of IVH in infants and children, and is still in the experimental research stage in animal models. The main feature of IVH in infants and children is brain white matter damage. IVH in infants and children can aggravate hydrocephalus and increase the lethality; it also often causes neurological dysfunction, such as epilepsy and cerebral palsy. There is no effective treatment to reduce brain injury and prevent the development of hydrocephalus. The results of experimental studies in animal models show that stem cell transplantation can reduce the inflammatory response of cerebrospinal fluid and brain tissue, prevent the development of hydrocephalus, reduce the death of brain cells and inhibit neurodegenerative lesions. VI. Outlook IVH, as a disease with high mortality and disability rate, increases the socioeconomic burden. Although the basic framework of IVH surgical treatment has been established, the lack of standardized treatment methods has led to many issues that need to be discussed, such as: (1) the determination of ultra-early surgical approach and time window; (2) the type and dosage of fibrinolytic drugs and the choice of treatment plan; (3) the location and duration of placement of extraventricular drains; (4) how to ensure the patency of cerebrospinal fluid circulation; (5) whether the above-mentioned treatments should be used alone or in combination; and (6) how to ensure the patency of cerebrospinal fluid circulation. (5) whether and how the above treatments should be used alone or in combination, etc. For the treatment of IVH, more clinical and laboratory studies are needed by researchers.