CT-guided stereotactic fibrinolysis of spontaneous and hypertensive cerebellar hemorrhage: long-term results

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✓ The surgical indication for spontaneous cerebellar hemorrhage is not as controversial as the operative management of intracranial hemorrhage. Timing of the operation is crucial: intervening too early can produce an additional strain on the patient and an increased risk, while waiting too long to evacuate the hematoma can be fatal. This dilemma may be a factor in the relatively high mortality and morbidity rates following both operative and conservative treatment that have been reported in the literature (42.5% and 30%, respectively).

In long-term studies on 14 patients, the authors have shown that stereotactic puncture and fibrinolysis for cerebellar hemorrhage is a valuable alternative to treatments used currently. The method consists of computerized tomography (CT)-guided stereotactic puncture and partial evacuation of the hematoma. After fibrinolysis with urokinase, the residual hematoma can be completely evacuated via a catheter introduced into the cavity of the hematoma. Only one of the 14 patients died in the direct postoperative phase; the remaining patients were enjoying a good to very good quality of life 6 months after the acute event. Two patients subsequently died as a result of pneumonia and cerebral infarction, respectively; both conditions were unrelated to the hemorrhage. The authors conclude that the CT-guided stereotactic method is simple, effective, and safe, and can be applied to patients of any age.

Article Information

Address reprint requests to: Mohsen Mahadjer, M.D., Klinikum der Albert-Ludwigs Universität Freiburg, Neurochirurgische Universitätsklinik, Abteilung Stereotaxie und Neuronuklearmedizin, Hugstetterstr. 55, D-7800 Freiburg, Federal Republic of Germany.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 4. Computerized tomography scans revealing recent hemorrhage in the right cerebellar hemisphere, displacement of the fourth ventricle and aqueduct, and compression of basal cisterns, particularly the ambient cistern.

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    Case 4. Computerized tomography scans taken 4 days after stereotactic evacuation and fibrinolysis in the same patient as described in Fig. 1.

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    Diagram showing the change in level of consciousness according to Glasgow Coma Scale26 scores (GCS), comparing the scores before and 48 hours after stereotactic evacuation in 14 patients with hypertensive cerebellar hemorrhage. Pat-No. = patient number.

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    Photomicrographs of brain tissue obtained from rats after injection of urokinase into the fourth ventricle. Semithin section 0.8 mm, azure-II-methylene blue, × 62. Left: Specimen from a rat brain 24 hours postinjection showing slight hemorrhaging in the puncture track. In the vicinity of the puncture site, normal ventricular ependyma can be observed. Right: Specimen from a rat brain 7 days postinjection showing the puncture track into the fourth ventricle filled with adipoid cells and reactive astroglia.

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