CT-guided stereotaxic evacuation of hypertensive intracerebral hematomas

Keizo Matsumoto M.D.1 and Hideki Hondo M.D.1
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  • 1 Department of Neurological Surgery, School of Medicine, University of Tokushima, Tokushima, Japan
Page Range:
440–448
Volume/Issue:
Volume 61: Issue 3
DOI link:
https://doi.org/10.3171/jns.1984.61.3.0440
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✓ Computerized tomography (CT) is now available for diagnosis and localization of intracerebral hematoma. Computerized tomography-guided stereotaxic evacuation of hypertensive intracerebral hematoma was performed in 51 cases: 34 basal ganglion hematomas with or without ventricular perforation, 11 subcortical hematomas, three thalamic hematomas, and three cerebellar hematomas. Three-dimensional CT images or biplane CT images were taken to determine the coordinates of the target point, which was the center of the hematoma. A silicone tube (3.5 mm in outer diameter and 2.1 mm in inner diameter) was then inserted into the center of the hematoma through a burr-hole under local anesthesia, and the liquefied or solid portion of the hematoma was aspirated with a syringe. Immediately after the first trial of hematoma aspiration, urokinase (6000 IU/5 ml saline) was administered through this silicone tube and the drain was clipped. Subsequently, aspiration and infusion of urokinase were repeated every 6 or 12 hours until the hematoma was completely evacuated. The silicone tube was removed when repeat CT scanning revealed no residual hematoma. The follow-up results indicate that this procedure is as good as conventional craniotomy and evacuation of hematoma under direct vision. This CT-guided stereotaxic approach for evacuation of the hematoma has the following advantages: 1) the procedure is simple and safe; 2) the operation can be performed under local anesthesia; and 3) the hematoma is completely drained with the aid of urokinase. This procedure seems indicated as an emergency treatment for elderly or high-risk patients who show no signs of cerebral herniation.

Volume 61: Issue 3 (Sep 1984)

in Journal of Neurosurgery
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