Effects of minimal-invasive installed tube aspiration treatment of hypertensive intracerebral hematoma by rt-PA / 中华急诊医学杂志

Objective To evaluate the effect of minimal-invasive installed tube aspiration treatment of hypertensive intracerebral hematoma by rt-PA.Methods Total 71 patients of hypertensive intracerebral hematoma were divided randomly into 3 groups.Group A with 23 patients,which were performed stereotactically placed catheter into the hematoma,and drained consistently;Group B with 24 patients,which were instilled urokinase to liquefy after stereotactically placed catheter and drained the hematoma in 8-hour intervals repeating 3 times over 6 hours;Group C with 24 patients,which were instilled rt-PA to liquefy after stereotactically placed catheter and drained the hematoma in 8-hour intervals repeating 3 times over 6 hours.One week later,the result of head CT scan were compared.Results The volume of hamatoma in CT scan decreased in three groups after therapy.Compared between pre-therapy and post-treatment, difference was significant (P＜0.05),but Group C was the effectivest.Conclusion It was effective and safe that using minimal-invasive installed tube aspiration treatment of hypertensive intracerebral hematoma by rt-PA.

Enhanced Focus in Hypertensive Intracerebral Hematoma on CT Scan and Hematoma Enlargement / 대한뇌혈관외과학회지

OBJECTIVE: Although most of hypertensive intracerebral hematoma (HICH) are static after ictus, a minority of them can enlarge in the acute phase after onset. This study performs to find the predicting factors and signs of hematoma enlargement in patients with HICH. METHODS: Among 140 cases of HICH treated during 1.5 years, the authors selected 107 cases who underwent contrast enhanced and nonenhanced initial CT scanning within 12 hours after symptom onset and a follow-up CT scan in order to investigate the enlargement of hematoma. Those cases were divided into two groups:hematoma enlargement (group I) and non-enlargement group (group II). The comparison of predicting factors (bleeding tendency, abnormal liver function and blood pressure) and signs (enhanced focus in hematoma on CT) of hematoma enlargement between group I and II was performed. RESULTS: There were 8 cases in group I and 99 cases in group II. The incidence of an enhanced focus in hematoma on CT scan was higher in group I than group II (87.5% vs. 9.1%, p<0.05). The systolic blood pressure (BP) at 6 hours after symptom onset and at the time of the first CT scan was higher in group I than group II (172.5 vs. 152.0 mm Hg, and 182.5 vs. 158.6 mm Hg, respectively, p<0.05). There was no difference in the incidence of bleeding tendency and abnormal liver function between group I and II. CONCLUSION: Contrast enhanced brain CT scan to detect the enhanced focus in the hematoma is one of useful methods to predict the early enlargement of hematoma in patients with HICH. The continuance of a high BP in spite of medication of antihypertensive drugs during the acute period after the onset of symptoms is another predictive sign of hematoma enlargement in patients with HICH.

Stereotactic Surgery in the Management of Hypertensive Intracerebral Hemorrhage: Evaluation of the Efficacy Using Continuous Intracranial Pressure Monitoring

Persistently elevated intracranial pressure(ICP) has been associated with poor clinical outcome after intracerebral hemorrhage(ICH). Increased ICP is one of the main target of treatment in hypertensive ICH. To evaluate the efficacy of stereotactic surgery for the patients with hypertensive ICH, continuous ICP monitoring was done in these patients. This study is based on 30 patients(39-75 years of age, with a mean age of 59.4 years) between January 1996 and December 1997, who had suffered hypertensive supratentorial ICH. All patients underwent partial removal of the hematoma(mean 11.8cc in volume) through the stereotactically placed catheters and the residual hematoma was drained by urokinase irrigation for average of 3.4 days. ICP was monitored in all cases starting before the surgery and continuously until two days after the surgery. Patients were assigned into three categories(Category A; less than 20mmHg, Category B; 20-30mmHg, and Category C; above 30mmHg) according to the initial(preoperative) ICP. Ten patients(39.5cc in average volume of hematoma) were defined to category A, six(45cc) to category B, and fourteen(62.4cc) to category C. After partial removal of the hematoma, there was statistically significant difference in drop of ICP(average 8.4mmHg in category A, 16mmHg in category B, and 36.7mmHg in category C)(p<0.001) and postoperative ICP was maintained under 20mmHg in all patients by urokinase irrigation and external drainage through the stereotactically placed catheters. Cerebral perfusion pressure(CPP) was maintained more than 90mmHg after partial removal of hematoma in all patients. This study demonstrates that ICP was controlled effectively by stereotactic external drainage with intermittent mannitol infusion under the continuous ICP monitoring without large decompressive surgery under general anesthesia for patients whose ICH volume was more than 60cc. Exception to this would be those with rapid progression of neurologic deterioration.

Stereotactic Aspiration of HICH by CT-Guided U-Loop and Leksell System

We reviewed 178 patients with hypertensive intracerebral hematoma(HICH), which were treated with computed tomography(CT) guided stereotactic aspiration from Aug. 1986 to Dec. 1993(166 CT guided U-loop and 12 Leksell system). Our series consisted of 82 males and 96 females. The hemorrhages were located in putamen in 67.4%, thalamus in 20.2%, subcortex in 9% and cerebellum in 3.4%. Mean removal rate of hematoma was 55.3%. The results for the 178 cases who underwent stereotactic aspiration were good recovery in 45.5%, moderate disability in 28.0%, severe disability in 9.0% and vegetative state in 4.0%. The infection rate and rebleeding rate of all cases were 1.7% and 6.8% respectively. The mortality rate of all cases was 13.5%. We analysed the factors affecting the prognosis in 178 patients. Factors affecting good prognosis were high initial GCS, less amount of initial hematoma and no presence of intraventricular hemorrhage. Stereotactic aspiration by CT-guided U-loop and Leksell system is simple, safe and can minimize the brain damage. This method can e performed under local anesthesia.

High Dose Urokinase Irrigation in the Management of Hypertensive Intracerebral Hematoma

It is well known that stereotaxic urokinase(UK) irrigation through a catheter is one of surgical methods in the management of hypertensive intracerebral hematoma(ICH) patients. Several authors recommended irrigation with 6000 IU UK, 4 times per a day. Based on authors' experience some patients who were managed with above protocol suffered from complications such as meningitis and/or pneumonia. It might be partially caused by prolonged duration of irrigation and immobilization of the patients. In order to reduce complications and to improve the final outcome of hypertensive ICH patients, we tried high dose UK irrigation(group II:irrigation with 50ml of normal saline mixed with 200,000 IU UK at immediate postoperative period, followed by two times of 20,000 IU UK irrigation per a day) to remove the ICH rapidly in those patients since Oct. 1991. We compared the rate of decreasing volume of hematoma, Glasgow coma scale(GCS) score change according to postoperative period, final outcome, and the rate of complications between this group(group II) and group I(4 times irrigation with 6,000 IU UK per a day). The results shows that the rate of decreasing volume of hematoma is slightly more rapid in group II than group I. The rate of poor outcome(vegetative and death) is lower in group II than I(group I vs. II:34% vs. 20% respectively). The rate of complication is lower in group II than I(group I vs. II:38.5% vs. 0.0%, respectively). One case(5%) of postoperative rebleeding was noted in group II. From this study, we concluded that, even if the beneficial effects are small, the high dose UK irrigation is one of protocols in the management of hypertensive ICH patients.

A Clinical Analysis of Stereotaxic Evacuation of Hypertensive Intracerebral Hematoma

Recent trend in the treatment of hypertensive intracerebral hematoma is stereotaxic surgery in preference to conservative treatment or conventional microsurgery. However, the three modalities of therapy have not been comparatively evaluated by objective criteria. Therefore, the authors analyzed 263 patients with hypertensive intracerebral hematoma who received various modes of treatment;54 CT guided stereotaxic evacuation, 73 craniotomy and 136 conserevative treatment. The results were summarized as followings: 1) In medium sized basal ganglia hematomas, the outcome of motor grade and Glagow outcome scale of craniotomy group, and the outcome of mental state, motor grade and Glasgow outcome scale of sterotactic evacuation group was better than that of conservative treatment group. 2) In two surgical groups, the subacute surgery group(24 hrs to 72 hrs) showed the best outcome of mental state but there was no significant difference between the outcomes of motor grade according to the time of surgery. 3) Among three groups, the mortality was the lowest in the stereotaxic evacuation group(9.3%) and highest in conservative treatment group(33.8%). In the patients with intraventricular hemorrhage, the mortality was significantly increas. 4) The stereotasic evacuation can minimize the brain damage and be performed under the local anesthesia. It can substitute the craniotomy or conservative treatment in the treatment of deep seated hematomas such as thalamus and basal ganglia.

A Clinical Analysis of Hypertensive Intracerebral Hematoma

Hypertensive intracerebral hematoma is a serious and potentially lethal condition. The indication of surgery in this hematoma is still controversial. Authors have treated 335 cases of hypertensive intracerebral hematomas which were confirmed by computerized tomography between July 1, 1982 and June 30, 1986. The hematomas have been classified according to their modes of extension on computerized tomography. The outcome was assessed on their basis of activity daily living. According to our study, moderate and severe types of putaminal hematoma cases have shown better results with surgery than conservative management. Mortality was 23.7 percent in surgery and 35.3 percent in conservative management.

Analysis on mortality rate of hypertensive intracerebrai hematoma treated wiih YL-I puncture hematoma evacuation / 重庆医科大学学报

Objective:To investigate the value of YL-1 puncture hematoma evacuation for hypertensive intracerebral hematoma.Methods:138 patients with hypertensive intracerecbral hematoma treated by YL-1 puncture hematoma evacuative were studied retrospectively,and the relationship between the age,the time of operation,GCS and volume of hemorrhage with mortality were with logistic regression method analysis.Results:①There were no significant relation in all the ages;②the shorter the hemorrhage,the higher the mortality;③the lower GCS was,the higher the mortality was;④the bigger the hemorrhage volume,the higher the mortality.Conclusion:The present study indicates that age is not an factor to limit minimally invasive operation(YL-1 puncture hematoma evacuation).The effect of surgery depended on the time of hemorrhage,GCS and volume of hemorrhage.

Treatment of Hypertensive Intracerebral Hematoma

212 cases of hypertensive intracerebral hematoma were treated and followed for more than 3 months. The outcome was analysed in point of comparison between conservative treatment and operative treatment. The precipitating factors on prognosis depend on size and site of hematoma, level of mental deterioration, and blood pressure on admisson. Operative treatment showed better outcome than conservative treatment in cases of severly mentally deteriorated patients, large hematoma, and pontine hematoma.