Fibrinolysis therapy achieved with tissue plasminogen activator and aspiration of the liquefied clot after experimental intracerebral hemorrhage: rapid reduction in hematoma volume but intensification of delayed edema formation

Veit RohdeDepartments of Neurosurgery, Neuroradiology, and Neuropathology, Aachen University, Germany

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Ina RohdeDepartments of Neurosurgery, Neuroradiology, and Neuropathology, Aachen University, Germany

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Ruth ThiexDepartments of Neurosurgery, Neuroradiology, and Neuropathology, Aachen University, Germany

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Azize InceDepartments of Neurosurgery, Neuroradiology, and Neuropathology, Aachen University, Germany

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Axel JungDepartments of Neurosurgery, Neuroradiology, and Neuropathology, Aachen University, Germany

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Gregor DückersDepartments of Neurosurgery, Neuroradiology, and Neuropathology, Aachen University, Germany

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Klaus GröschelDepartments of Neurosurgery, Neuroradiology, and Neuropathology, Aachen University, Germany

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Carina RöttgerDepartments of Neurosurgery, Neuroradiology, and Neuropathology, Aachen University, Germany

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Wilhelm KükerDepartments of Neurosurgery, Neuroradiology, and Neuropathology, Aachen University, Germany

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Harald D. MüllerDepartments of Neurosurgery, Neuroradiology, and Neuropathology, Aachen University, Germany

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Joachim M. GilsbachDepartments of Neurosurgery, Neuroradiology, and Neuropathology, Aachen University, Germany

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Object. Fibrinolysis therapy accomplished using tissue plasminogen activator (tPA) and aspiration is considered to be a viable alternative to microsurgery and medical therapy for the treatment of deep-seated spontaneous intracerebral hematomas (SICHs). Tissue plasminogen activator is a mediator of thrombin- and ischemia-related delayed edema. Because both thrombin release and ischemia occur after SICH, the authors planned to investigate the effect of fibrinolytic therapy on hematoma and delayed edema volume.

Methods. A spherical hematoma was created in the frontal white matter of 18 pigs. In the tPA-treated group (nine pigs), a mean of 1.55 ml tPA was injected into the clot and the resulting liquefied blood was aspirated. Magnetic resonance (MR) imaging was performed on Days 0 (after surgery), 4, and 10, and the volumes of hematoma and edema were determined. In the animals not treated with tPA (untreated group; nine pigs), the volume of hematoma dropped from 1.43 ± 0.42 ml on Day 0 to 0.85 ± 0.28 ml on Day 10. In the tPA-treated group, the volume of hematoma was reduced from 1.51 ± 0.28 ml on Day 0 to 0.52 ± 0.39 ml on Day 10. In comparison with the untreated group, the reduction in hematoma volume was significantly accelerated (p = 0.02). In the untreated group, perihematomal edema increased from 0.32 ± 0.61 ml to 1.73 ± 0.73 ml on Day 4, before dropping to 1.17 ± 0.92 ml on Day 10. In the tPA-treated group, the volume of the edema increased from 0.09 ± 0.21 ml on Day 0 to 1.93 ± 0.79 ml on Day 4, and further to 3.34 ± 3.21 ml on Day 10. The increase in edema volume was significantly more pronounced in the tPA-treated group (p = 0.04).

Conclusions. Despite a significantly accelerated reduction in hematoma volume, the development of delayed perifocal edema was intensified by fibrinolytic therapy, which is probably related to the function of tPA as a mediator of edema formation after thrombin release and ischemia. Further experimental and clinical investigations are required to establish the future role of fibrinolysis in the management of SICH.

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  • 1.

    Altumbabic M, , Peeling J, & Del Bigio MR: Intracerebral hemorrhage in the rat: effects of hematoma aspiration. Stroke 29:19171923, 1998 Altumbabic M, Peeling J, Del Bigio MR: Intracerebral hemorrhage in the rat: effects of hematoma aspiration. Stroke 29:1917–1923, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Aydin IH, , Takci E, & Kadioglu HH, et al: The effect of urokinase on experimental intracerebral haematomas. Zentralbl Neurochir 55:2934, 1994 Aydin IH, Takci E, Kadioglu HH, et al: The effect of urokinase on experimental intracerebral haematomas. Zentralbl Neurochir 55:29–34, 1994

    • Search Google Scholar
    • Export Citation
  • 3.

    Batjer HH, , Reisch JS, & Allen BC, et al: Failure of surgery to improve outcome in hypertensive putaminal hemorrhage. A prospective randomized trial. Arch Neurol 47:11031106, 1990 Batjer HH, Reisch JS, Allen BC, et al: Failure of surgery to improve outcome in hypertensive putaminal hemorrhage. A prospective randomized trial. Arch Neurol 47:1103–1106, 1990

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Broderick JP, , Adams HP Jr, & Barsan W, et al: Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 30:905915, 1999 Broderick JP, Adams HP Jr, Barsan W, et al: Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 30:905–915, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Broderick JP, , Brott T, & Tomsick T, et al: Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg 78:188191, 1993 Broderick JP, Brott T, Tomsick T, et al: Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg 78:188–191, 1993

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Chen X, , Yang H, & Czherig Z: A prospective randomized trial of surgical and conservative treatment of hypertensive intracranial haemorrhage. Acta Acad Med Shanghai 19:237240, 1992 (Reference unverified) Chen X, Yang H, Czherig Z: A prospective randomized trial of surgical and conservative treatment of hypertensive intracranial haemorrhage. Acta Acad Med Shanghai 19:237–240, 1992 (Reference unverified)

    • Search Google Scholar
    • Export Citation
  • 7.

    Daverat P, , Castel JP, & Dartigues JF, et al: Death and functional outcome after spontaneous intracerebral hemorrhage. A prospective study of 166 cases using multivariate analysis. Stroke 22:16, 1991 Daverat P, Castel JP, Dartigues JF, et al: Death and functional outcome after spontaneous intracerebral hemorrhage. A prospective study of 166 cases using multivariate analysis. Stroke 22:1–6, 1991

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Deinsberger W, , Vogel J, & Fuchs C, et al: Fibrinolysis and aspiration of experimental intracerebral hematoma reduces the volume of ischemic brain in rats. Neurol Res 21:517523, 1999 Deinsberger W, Vogel J, Fuchs C, et al: Fibrinolysis and aspiration of experimental intracerebral hematoma reduces the volume of ischemic brain in rats. Neurol Res 21:517–523, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Deinsberger W, , Vogel J, & Kuschnisky W, et al: Experimental intracerebral hemorrhage: description of a double injection model in rats. Neurol Res 18:475477, 1996 Deinsberger W, Vogel J, Kuschnisky W, et al: Experimental intracerebral hemorrhage: description of a double injection model in rats. Neurol Res 18:475–477, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Del Bigio MR, , Yan HJ, & Buist R, et al: Experimental intracerebral hemorrhage in rats. Magnetic resonance imaging and histopathological correlates. Stroke 27:23122320, 1996 Del Bigio MR, Yan HJ, Buist R, et al: Experimental intracerebral hemorrhage in rats. Magnetic resonance imaging and histopathological correlates. Stroke 27:2312–2320, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Enzmann DR, , Britt RH, & Lyons BE, et al: Natural history of experimental intracerebral hemorrhage: sonography, computed tomography and neuropathology. AJNR 2:517526, 1981 Enzmann DR, Britt RH, Lyons BE, et al: Natural history of experimental intracerebral hemorrhage: sonography, computed tomography and neuropathology. AJNR 2:517–526, 1981

    • Search Google Scholar
    • Export Citation
  • 12.

    Fieschi C, , Carolei A, & Fiorelli M, et al: Changing prognosis of primary intracerebral hemorrhage: results of a clinical and computed tomographic follow-up study of 104 patients. Stroke 19:192195, 1988 Fieschi C, Carolei A, Fiorelli M, et al: Changing prognosis of primary intracerebral hemorrhage: results of a clinical and computed tomographic follow-up study of 104 patients. Stroke 19:192–195, 1988

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Figueroa BE, , Keep RF, & Betz AL, et al: Plasminogen activators potentiate thrombin-induced brain injury. Stroke 29:12021208, 1998 Figueroa BE, Keep RF, Betz AL, et al: Plasminogen activators potentiate thrombin-induced brain injury. Stroke 29:1202–1208, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Findlay JM, , Weir BKA, & Kassell NF, et al: Intracisternal recombinant tissue plasminogen activator after aneurysmal subarachnoid hemorrhage. J Neurosurg 75:181188, 1991 Findlay JM, Weir BKA, Kassell NF, et al: Intracisternal recombinant tissue plasminogen activator after aneurysmal subarachnoid hemorrhage. J Neurosurg 75:181–188, 1991

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Flemming KD, , Wijdicks EFM, & St Louis EK, et al: Predicting deterioration in patients with lobar haemorrhages. J Neurol Neurosurg Psychiatry 66:600605, 1999 Flemming KD, Wijdicks EFM, St Louis EK, et al: Predicting deterioration in patients with lobar haemorrhages. J Neurol Neurosurg Psychiatry 66:600–605, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Fujii Y, , Tanaka R, & Takeuchi S, et al: Hematoma enlargement in spontaneous intracerebral hemorrhage. J Neurosurg 80:5157, 1994 Fujii Y, Tanaka R, Takeuchi S, et al: Hematoma enlargement in spontaneous intracerebral hemorrhage. J Neurosurg 80:51–57, 1994

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Giroud M, , Gras P, & Chadan N, et al: Cerebral haemorrhage in a French prospective population study. J Neurol Neurosurg Psychiatry 54:595598, 1991 Giroud M, Gras P, Chadan N, et al: Cerebral haemorrhage in a French prospective population study. J Neurol Neurosurg Psychiatry 54:595–598, 1991

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Hickenbottom SL, , Grotta JC, & Strong R, et al: Nuclear factor-κB and cell death after experimental intracerebral hemorrhage in rats. Stroke 30:24722478, 1999 Hickenbottom SL, Grotta JC, Strong R, et al: Nuclear factor-κB and cell death after experimental intracerebral hemorrhage in rats. Stroke 30:2472–2478, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Hua Y, , Xi G, & Keep RF, et al: Complement activation in the brain after experimental intracerebral hemorrhage. J Neurosurg 92:10161022, 2000 Hua Y, Xi G, Keep RF, et al: Complement activation in the brain after experimental intracerebral hemorrhage. J Neurosurg 92:1016–1022, 2000

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Huang FP, , Xi G, & Keep RF, et al: Brain edema after experimental intracerebral hemorrhage: role of hemoglobin degradation products. J Neurosurg 96:287293, 2002 Huang FP, Xi G, Keep RF, et al: Brain edema after experimental intracerebral hemorrhage: role of hemoglobin degradation products. J Neurosurg 96:287–293, 2002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Husstedt HW, , Sickert M, & Köstler H, et al: Diagnostic value of the fast-FLAIR sequence in MR imaging of intracranial tumors. Eur Radiol 10:745752, 2000 Husstedt HW, Sickert M, Köstler H, et al: Diagnostic value of the fast-FLAIR sequence in MR imaging of intracranial tumors. Eur Radiol 10:745–752, 2000

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Janny P, , Colnet G, & Georget AM, et al: Intracranial pressure with intracerebral hemorrhages. Surg Neurol 10:371375, 1978 Janny P, Colnet G, Georget AM, et al: Intracranial pressure with intracerebral hemorrhages. Surg Neurol 10:371–375, 1978

    • Search Google Scholar
    • Export Citation
  • 23.

    Juvela S, , Heiskanen O, & Poranen A, et al: The treatment of spontaneous intracerebral hemorrhage. A prospective randomized trial of surgical and conservative treatment. J Neurosurg 70:755758, 1989 Juvela S, Heiskanen O, Poranen A, et al: The treatment of spontaneous intracerebral hemorrhage. A prospective randomized trial of surgical and conservative treatment. J Neurosurg 70:755–758, 1989

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Kajimoto Y, , Ohta T, & Kuroiwa T: Comparison of intrathecally administered urokinase, tissue-type plasminogen activator, and combination of urokinase and lysine-plasminogen for clot lysis after experimental subarachnoid hemorrhage in dogs. Neurosurgery 40:572577, 1997 Kajimoto Y, Ohta T, Kuroiwa T: Comparison of intrathecally administered urokinase, tissue-type plasminogen activator, and combination of urokinase and lysine-plasminogen for clot lysis after experimental subarachnoid hemorrhage in dogs. Neurosurgery 40:572–577, 1997

    • Search Google Scholar
    • Export Citation
  • 25.

    Kane PJ, , Modha P, & Strachan RD, et al: The effect of immunosuppression on the development of cerebral oedema in an experimental model of intracerebral haemorrhage: whole body and regional irradiation. J Neurol Neurosurg Psychiatry 55:781786, 1992 Kane PJ, Modha P, Strachan RD, et al: The effect of immunosuppression on the development of cerebral oedema in an experimental model of intracerebral haemorrhage: whole body and regional irradiation. J Neurol Neurosurg Psychiatry 55:781–786, 1992

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Kaneko M, , Tanak K, & Shimada T, et al: Long-term evaluation of ultra-early operation for hypertensive intracerebral hemorrhage in 100 cases. J Neurosurg 58:838842, 1983 Kaneko M, Tanak K, Shimada T, et al: Long-term evaluation of ultra-early operation for hypertensive intracerebral hemorrhage in 100 cases. J Neurosurg 58:838–842, 1983

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Kaufman HH, , Schochet S, & Koss W, et al: Efficacy and safety of tissue plasminogen activator. Neurosurgery 20:403407, 1987 Kaufman HH, Schochet S, Koss W, et al: Efficacy and safety of tissue plasminogen activator. Neurosurgery 20:403–407, 1987

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Kothari RU, , Brott T, & Broderick JP, et al: The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27:13041305, 1996 Kothari RU, Brott T, Broderick JP, et al: The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27:1304–1305, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Lee KR, , Betz AL, & Kim S, et al: The role of the coagulation cascade in brain edema formation after intracerebral hemorrhage. Acta Neurochir 138:396401, 1996 Lee KR, Betz AL, Kim S, et al: The role of the coagulation cascade in brain edema formation after intracerebral hemorrhage. Acta Neurochir 138:396–401, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Lee KR, , Colon GP, & Betz AL, et al: Edema from intracerebral hemorrhage: the role of thrombin. J Neurosurg 84:9196, 1996 Lee KR, Colon GP, Betz AL, et al: Edema from intracerebral hemorrhage: the role of thrombin. J Neurosurg 84:91–96, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Lee KR, , Kawai N, & Kim S, et al: Mechanisms of edema formation after intracerebral hemorrhage: effects of thrombin on cerebral blood flow, blood—brain barrier permeability, and cell survival in a rat model. J Neurosurg 86:272278, 1997 Lee KR, Kawai N, Kim S, et al: Mechanisms of edema formation after intracerebral hemorrhage: effects of thrombin on cerebral blood flow, blood—brain barrier permeability, and cell survival in a rat model. J Neurosurg 86:272–278, 1997

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32.

    Lippitz BE, , Mayfrank L, & Spetzger U, et al: Lysis of basal ganglia haematoma with recombinant tissue plasminogen activator (rtPA) after stereotactic aspiration: initial results. Acta Neurochir 127:157160, 1994 Lippitz BE, Mayfrank L, Spetzger U, et al: Lysis of basal ganglia haematoma with recombinant tissue plasminogen activator (rtPA) after stereotactic aspiration: initial results. Acta Neurochir 127:157–160, 1994

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Lipton SA, & Rosenberg PA: Excitatory amino acids as a final common pathway for neurologic disorders. N Engl J Med 330:613622, 1994 Lipton SA, Rosenberg PA: Excitatory amino acids as a final common pathway for neurologic disorders. N Engl J Med 330:613–622, 1994

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Marder VJ, & Sherry S: Thrombolytic therapy: current status. N Engl J Med 318:15121520, 1988 Marder VJ, Sherry S: Thrombolytic therapy: current status. N Engl J Med 318:1512–1520, 1988

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    Masada T, , Hua Y, & Xi G, et al: Attenuation of intracerebral hemorrhage and thrombin-induced brain edema by overexpression of interleukin-1 receptor antagonist. J Neurosurg 95:680686, 2001 Masada T, Hua Y, Xi G, et al: Attenuation of intracerebral hemorrhage and thrombin-induced brain edema by overexpression of interleukin-1 receptor antagonist. J Neurosurg 95:680–686, 2001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    Masuda T, , Dohrmann GJ, & Kwaan HC, et al: Fibrinolytic activity in experimental intracerebral hematoma. J Neurosurg 68:274278, 1988 Masuda T, Dohrmann GJ, Kwaan HC, et al: Fibrinolytic activity in experimental intracerebral hematoma. J Neurosurg 68:274–278, 1988

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37.

    Matsuo O, , Rijken DC, & Collen D: Comparison of the relative fibrinogenolytic, fibrinolytic and thrombolytic properties of tissue plasminogen activator and urokinase in vitro. Thromb Haemost 45:225229, 1981 Matsuo O, Rijken DC, Collen D: Comparison of the relative fibrinogenolytic, fibrinolytic and thrombolytic properties of tissue plasminogen activator and urokinase in vitro. Thromb Haemost 45:225–229, 1981

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38.

    Mayer SA, , Lignelli A, & Fink ME, et al: Perilesional blood flow and edema formation in acute intracerebral hemorrhage: a SPECT study. Stroke 29:17911798, 1998 Mayer SA, Lignelli A, Fink ME, et al: Perilesional blood flow and edema formation in acute intracerebral hemorrhage: a SPECT study. Stroke 29:1791–1798, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 39.

    Mayer SA, , Sacco RL, & Shi T, et al: Neurologic deterioration in noncomatose patients with supratentorial intracerebral hemorrhage. Neurology 44:13791384, 1994 Mayer SA, Sacco RL, Shi T, et al: Neurologic deterioration in noncomatose patients with supratentorial intracerebral hemorrhage. Neurology 44:1379–1384, 1994

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40.

    Mayfrank L, , Lippitz B, & Groth M, et al: Effect of recombinant tissue plasminogen activator on clot lysis and ventricular dilatation in the treatment of severe intraventricular haemorrhage. Acta Neurochir 122:3238, 1993 Mayfrank L, Lippitz B, Groth M, et al: Effect of recombinant tissue plasminogen activator on clot lysis and ventricular dilatation in the treatment of severe intraventricular haemorrhage. Acta Neurochir 122:32–38, 1993

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41.

    McKissock W, , Richardson A, & Taylor J: Primary intracerebral haemorrhage. A controlled trial of surgical and conservative treatment in 180 unselected cases. Lancet 2:221226, 1961 McKissock W, Richardson A, Taylor J: Primary intracerebral haemorrhage. A controlled trial of surgical and conservative treatment in 180 unselected cases. Lancet 2:221–226, 1961

    • Search Google Scholar
    • Export Citation
  • 42.

    Menzies SA, , Betz AL, & Hoff JT: Contributions of ions and albumin to the formation and resolution of ischemic brain edema. J Neurosurg 78:257266, 1993 Menzies SA, Betz AL, Hoff JT: Contributions of ions and albumin to the formation and resolution of ischemic brain edema. J Neurosurg 78:257–266, 1993

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43.

    Mohadjer M, , Eggert R, & May J, et al: CT-guided stereotactic fibrinolysis of spontaneous and hypertensive cerebellar hemorrhage: long-term results. J Neurosurg 73:217222, 1990 Mohadjer M, Eggert R, May J, et al: CT-guided stereotactic fibrinolysis of spontaneous and hypertensive cerebellar hemorrhage: long-term results. J Neurosurg 73:217–222, 1990

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 44.

    Montes JM, , Wong JH, & Fayad PB, et al: Stereotactic computed tomographic-guided aspiration and thrombolysis of intracerebral hematoma: protocol and preliminary experience. Stroke 31:834840, 2000 Montes JM, Wong JH, Fayad PB, et al: Stereotactic computed tomographic-guided aspiration and thrombolysis of intracerebral hematoma: protocol and preliminary experience. Stroke 31:834–840, 2000

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45.

    Morgenstern LB, , Demchuk AM, & Kim DH, et al: Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage. Neurology 56:12941299, 2001 Morgenstern LB, Demchuk AM, Kim DH, et al: Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage. Neurology 56:1294–1299, 2001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 46.

    Morgenstern LB, , Frankowski RF, & Shedden P, et al: Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial. Neurology 51:13591363, 1998 Morgenstern LB, Frankowski RF, Shedden P, et al: Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial. Neurology 51:1359–1363, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 47.

    Narayan RK, , Narayan TM, & Katz DA, et al: Lysis of intracranial hematomas with urokinase in a rabbit model. J Neurosurg 62:580586, 1985 Narayan RK, Narayan TM, Katz DA, et al: Lysis of intracranial hematomas with urokinase in a rabbit model. J Neurosurg 62:580–586, 1985

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 48.

    Nath FP, , Jenkins A, & Mendelow AD, et al: Early hemodynamic changes in experimental intracerebral hemorrhage. J Neurosurg 65:697703, 1986 Nath FP, Jenkins A, Mendelow AD, et al: Early hemodynamic changes in experimental intracerebral hemorrhage. J Neurosurg 65:697–703, 1986

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 49.

    Nath FP, , Kelly PT, & Jenkins A, et al: Effects of experimental intracerebral hemorrhage on blood flow, capillary permeability, and histochemistry. J Neurosurg 66:555562, 1987 Nath FP, Kelly PT, Jenkins A, et al: Effects of experimental intracerebral hemorrhage on blood flow, capillary permeability, and histochemistry. J Neurosurg 66:555–562, 1987

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 50.

    Nehls DG, , Mendelow DA, & Graham DI, et al: Experimental intracerebral hemorrhage: early removal of a spontaneous mass lesion improves late outcome. Neurosurgery 27:674682, 1990 Nehls DG, Mendelow DA, Graham DI, et al: Experimental intracerebral hemorrhage: early removal of a spontaneous mass lesion improves late outcome. Neurosurgery 27:674–682, 1990

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 51.

    Niizuma H, , Shimizu Y, & Yonemitsu T, et al: Results of stereotactic aspiration in 175 cases of putaminal hemorrhage. Neurosurgery 24:814819, 1989 Niizuma H, Shimizu Y, Yonemitsu T, et al: Results of stereotactic aspiration in 175 cases of putaminal hemorrhage. Neurosurgery 24:814–819, 1989

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 52.

    Nilsson OG, , Brandt L, & Ungerstedt U, et al: Bedside detection of brain ischemia using intracerebral microdialysis: subarachnoid hemorrhage and delayed ischemic deterioration. Neurosurgery 45:11761185, 1999 Nilsson OG, Brandt L, Ungerstedt U, et al: Bedside detection of brain ischemia using intracerebral microdialysis: subarachnoid hemorrhage and delayed ischemic deterioration. Neurosurgery 45:1176–1185, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 53.

    Papo I, , Janny P, & Caruselli G, et al: Intracranial pressure time course in primary intracerebral hemorrhage. Neurosurgery 4:504511, 1979 Papo I, Janny P, Caruselli G, et al: Intracranial pressure time course in primary intracerebral hemorrhage. Neurosurgery 4:504–511, 1979

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 54.

    Qureshi AI, , Safdar K, & Weil EJ, et al: Predictors of early deterioration and mortality in black Americans with spontaneous intracerebral hemorrhage. Stroke 26:17641767, 1995 Qureshi AI, Safdar K, Weil EJ, et al: Predictors of early deterioration and mortality in black Americans with spontaneous intracerebral hemorrhage. Stroke 26:1764–1767, 1995

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 55.

    Regan RF, & Panter SS: Hemoglobin potentiates excitotoxic injury in cortical cell culture. J Neurotrauma 13:223231, 1996 Regan RF, Panter SS: Hemoglobin potentiates excitotoxic injury in cortical cell culture. J Neurotrauma 13:223–231, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 56.

    Rohde V, , Rohde I, & Reinges MH, et al: Frameless stereotactically guided catheter placement and fibrinolytic therapy for spontaneous intracerebral hematomas: technical aspects and initial clinical results. Minim Invasive Neurosurg 43:917, 2000 Rohde V, Rohde I, Reinges MH, et al: Frameless stereotactically guided catheter placement and fibrinolytic therapy for spontaneous intracerebral hematomas: technical aspects and initial clinical results. Minim Invasive Neurosurg 43:9–17, 2000

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 57.

    Rohde V, , Rohde I, & Thiex R, et al: The role of intraoperative magnetic resonance imaging for the detection of hemorrhagic complications during surgery of intracerebral lesions: an experimental approach. Surg Neurol 56:266275, 2001 Rohde V, Rohde I, Thiex R, et al: The role of intraoperative magnetic resonance imaging for the detection of hemorrhagic complications during surgery of intracerebral lesions: an experimental approach. Surg Neurol 56:266–275, 2001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 58.

    Rohde V, , Schaller C, & Hassler WE: Intraventricular recombinant tissue plasminogen activator for lysis of intraventricular haemorrhage. J Neurol Neurosurg Psychiatry 58:447451, 1995 Rohde V, Schaller C, Hassler WE: Intraventricular recombinant tissue plasminogen activator for lysis of intraventricular haemorrhage. J Neurol Neurosurg Psychiatry 58:447–451, 1995

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 59.

    Rosenberg GA, , Mun-Bryce S, & Wesley M, et al: Collagenase-induced intracerebral hemorrhage in rats. Stroke 21:801807, 1990 Rosenberg GA, Mun-Bryce S, Wesley M, et al: Collagenase-induced intracerebral hemorrhage in rats. Stroke 21:801–807, 1990

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 60.

    Schaller C, , Rohde V, & Meyer B, et al: Stereotactic puncture and lysis of spontaneous intracerebral hemorrhage using recombinant tissue-plasminogen activator. Neurosurgery 36:328335, 1995 Schaller C, Rohde V, Meyer B, et al: Stereotactic puncture and lysis of spontaneous intracerebral hemorrhage using recombinant tissue-plasminogen activator. Neurosurgery 36:328–335, 1995

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 61.

    Schütz H, , Bödeker RH, & Damian M, et al: Age-related spontaneous intracerebral hematoma in a German community. Stroke 21:114121418, 1990 Schütz H, Bödeker RH, Damian M, et al: Age-related spontaneous intracerebral hematoma in a German community. Stroke 21:11412–1418, 1990

    • Search Google Scholar
    • Export Citation
  • 62.

    Shatos MA, , Doherty JM, & Penar PL, et al: Suppression of plasminogen activator inhibitor-1 release from human cerebral endothelium by plasminogen activators. [A factor potentially predisposing to intracranial bleeding.] Circulation 94:636642, 1996 Shatos MA, Doherty JM, Penar PL, et al: Suppression of plasminogen activator inhibitor-1 release from human cerebral endothelium by plasminogen activators. [A factor potentially predisposing to intracranial bleeding.] Circulation 94:636–642, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 63.

    Sinar EJ, , Mendelow AD, & Graham DI, et al: Experimental intracerebral hemorrhage: effects of a temporary mass lesion. J Neurosurg 66:568576, 1987 Sinar EJ, Mendelow AD, Graham DI, et al: Experimental intracerebral hemorrhage: effects of a temporary mass lesion. J Neurosurg 66:568–576, 1987

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 64.

    Tanizaki Y: Improvement of cerebral blood flow following stereotactic surgery in patients with putaminal haemorrhage. Acta Neurochir 90:103110, 1988 Tanizaki Y: Improvement of cerebral blood flow following stereotactic surgery in patients with putaminal haemorrhage. Acta Neurochir 90:103–110, 1988

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 65.

    Tokutomi T, , Hirohata M, & Miyagi T, et al: Posttraumatic edema in the corpus callosum shown by MRI. Acta Neurochir Suppl 70:8083, 1997 Tokutomi T, Hirohata M, Miyagi T, et al: Posttraumatic edema in the corpus callosum shown by MRI. Acta Neurochir Suppl 70:80–83, 1997

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 66.

    Tsirka SE, , Rogove AD, & Strickland S: Neuronal cell death and tPA. Nature 384:123124, 1996 Tsirka SE, Rogove AD, Strickland S: Neuronal cell death and tPA. Nature 384:123–124, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 67.

    Vespa P, , Prins M, & Ronne-Engstrom E, et al: Increase in extracellular glutamate caused by reduced cerebral perfusion pressure and seizures after human traumatic brain injury: a microdialysis study. J Neurosurg 89:971982, 1998 Vespa P, Prins M, Ronne-Engstrom E, et al: Increase in extracellular glutamate caused by reduced cerebral perfusion pressure and seizures after human traumatic brain injury: a microdialysis study. J Neurosurg 89:971–982, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 68.

    Wagner KR, , Xi G, & Hua Y, et al: Lobar intracerebral hemorrhage model in pigs: neurologic and neuropathologic outcomes and improved brain energy state after hematoma evacuation. J Cereb Blood Flow Metab 15 (Suppl 1):S28, 1995 (Abstract) Wagner KR, Xi G, Hua Y, et al: Lobar intracerebral hemorrhage model in pigs: neurologic and neuropathologic outcomes and improved brain energy state after hematoma evacuation. J Cereb Blood Flow Metab 15 (Suppl 1):S28, 1995 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 69.

    Wagner KR, , Xi G, & Hua Y, et al: Lobar intracerebral hemorrhage model in pigs: rapid edema development in perihematomal white matter. Stroke 27:490497, 1996 Wagner KR, Xi G, Hua Y, et al: Lobar intracerebral hemorrhage model in pigs: rapid edema development in perihematomal white matter. Stroke 27:490–497, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 70.

    Wagner KR, , Xi G, & Hua Y, et al: Ultra-early clot aspiration after lysis with tissue plasminogen activator in a porcine model of intracerebral hemorrhage: edema reduction and blood-brain barrier protection. J Neurosurg 90:491498, 1999 Wagner KR, Xi G, Hua Y, et al: Ultra-early clot aspiration after lysis with tissue plasminogen activator in a porcine model of intracerebral hemorrhage: edema reduction and blood-brain barrier protection. J Neurosurg 90:491–498, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 71.

    Wang YF, , Tsirka SE, & Strickland S, et al: Tissue plasminogen activator (tPA) increases neuronal damage after focal cerebral ischemia in wild-type and tPA-deficient mice. Nat Med 4:228231, 1998 Wang YF, Tsirka SE, Strickland S, et al: Tissue plasminogen activator (tPA) increases neuronal damage after focal cerebral ischemia in wild-type and tPA-deficient mice. Nat Med 4:228–231, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 72.

    Xi G, , Keep RF, & Hoff JT: Erythrocytes and delayed brain edema formation following intracerebral hemorrhage in rats. J Neurosurg 89:991996, 1998 Xi G, Keep RF, Hoff JT: Erythrocytes and delayed brain edema formation following intracerebral hemorrhage in rats. J Neurosurg 89:991–996, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 73.

    Xi G, , Wagner KR, & Keep RF, et al: Role of blood clot formation on early edema development after experimental intracerebral hemorrhage. Stroke 29:25802586, 1998 Xi G, Wagner KR, Keep RF, et al: Role of blood clot formation on early edema development after experimental intracerebral hemorrhage. Stroke 29:2580–2586, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 74.

    Xue M, & De lBigio MR: Intracortical hemorrhage injury in rats: relationship between blood fractions and brain cell death. Stroke 31:17211727, 2000 Xue M, De lBigio MR: Intracortical hemorrhage injury in rats: relationship between blood fractions and brain cell death. Stroke 31:1721–1727, 2000

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 75.

    Zabramski JM, , Spetzler RF, & Lee KS, et al: Phase I trial of tissue plasminogen activator for the prevention of vasospasm in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 75:189196, 1991 Zabramski JM, Spetzler RF, Lee KS, et al: Phase I trial of tissue plasminogen activator for the prevention of vasospasm in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 75:189–196, 1991

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 76.

    Zazulia AR, , Diringer MN, & Derdeyn CP, et al: Progression of mass effect after intracerebral hemorrhage. Stroke 30:11671173, 1999 Zazulia AR, Diringer MN, Derdeyn CP, et al: Progression of mass effect after intracerebral hemorrhage. Stroke 30:1167–1173, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 77.

    Zimmerman RA: Recent advances in MR imaging: FLAIR imaging. Crit Rev Neurosurg 8:188192, 1998 Zimmerman RA: Recent advances in MR imaging: FLAIR imaging. Crit Rev Neurosurg 8:188–192, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 78.

    Zuccarello M, , Wagner KR, & Dean CP, et al: Tissue plasminogen activator for intracerebral hematoma removal: beneficial or harmful? J Neurosurg 96:185A186A, 2002 (Abstract) Zuccarello M, Wagner KR, Dean CP, et al: Tissue plasminogen activator for intracerebral hematoma removal: beneficial or harmful? J Neurosurg 96:185A–186A, 2002 (Abstract)

    • Search Google Scholar
    • Export Citation

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