Controlled Evacuation of Spontaneous Intracranial Hematoma with CT-aided Stereotaxic Urokinase Therapy

ABSTRACT

Authors describe methods for evacuation of intracerebral and/or intraventricular hematomas with CT-aided stereotaxic infusion of urokinase into the hematoma and controlled drainage. In the past 6 months we performed the procedures in 21 cases during acute(within 3 days) or subacute(between 4 and 14 days) stage after the apoplectic attack. Three dimensional CT images were used to locate the hematoma sites, to assess its volume and to determine stereotaxic coordinates. Under local anesthesia a silicon tube was inserted into the hematoma through burr hole and the hematoma was aspirated with syringe. And then urokinase(6,000IU/5ml saline) was infused into the hematoma and the drain was clipped. There after aspiration and administration were performed repeatedly every 6 hours until the hematoma was completely removed. In cases of intraventricular hematoma a drain was inserted into the ventricle having the main hematoma. As a first trial of hematoma removal, the ventricle was irrigated with urokinase(6,000IU/100ml saline), and the drain was clipped after administration of urokinase(6,000IU/5ml saline). Subsequentry clipping of the drain for 4 hours and drainage of the CSF with the hematoma for 2 hours were repeated under the monitoring of intracranial pressure. Now we review serial changes of CT findings and results of 10 cases which were followed up for at least 4 months' and preliminarily conclude that this procedure may be as good as conventional cranitomy, and safer and less traumatic than any other management especially in cases of intraventricular or deep seated hematomas and elderly or high-risk patients.