Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Stereotactic Multiplanar Reformatted Computed Tomography-Guided Catheter Placement and Thrombolysis of Spontaneous Intracerebral Hematomas

  • Hwang, Jae-Ha (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Han, Jong-Woo (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Park, Kyung-Bum (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Lee, Chul-Hee (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Park, In-Sung (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Jung, Jin-Myung (Department of Neurosurgery, Gyeongsang National University School of Medicine)
  • Published : 2008.10.28
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Abstract

Objective : The authors present their experiences with stereotactic multiplanar reformatted (MPR) computed tomography (CT)-guided catheter placement for thrombolysis of spontaneous intracerebral hematoma (sICH) and their clinical results. Methods : In 23 patients with sICH, MPR CT-guided catheter placement was used to select the trajectory and target point of hematoma drainage. This group was comprised of 11 men and 12 women, and the mean age was 57.5 years (range, 31-79 years). The patients' initial Glasgow Coma Scale scores ranged from 7 to 15 with a median of 11. The volume of the hematoma ranged from 24 mL to 86 mL (mean 44.5 mL). A trajectory along the main axis of the hematoma was considered to be optimal for thrombolytic therapy. The trajectory was calculated from the point of entry through the target point of the hematoma using reformatted images. Results : The hematoma catheter was left in place for a median duration of 48.9 hours (range 34 to 62 hours). In an average of two days, the average residual hematoma volume was 6.2 mL (range 1.4 mL to 10.2 mL) and was reduced by an average of 84.7% (range 71.6% to 96.3%). The residual hematoma at postoperative seven days was less than 5 mL in all patients. There was no treatment-related death during hospitalization. Conclusion : The present study indicates that stereotactic MPR CT-guided catheter placement for thrombolysis is an accurate and safe procedure. We suggest that this procedure for stereotactic removal of sICH should be considered for the optimization of the trajectory selection in the future.

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References

  1. Auer LM, Deinsberger W, Niederkorn K, Gell G, Kleinert R, Schneider G, et al : Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma : a randomized study. J Neurosurg 70 : 530-535, 1989 https://doi.org/10.3171/jns.1989.70.4.0530
  2. Backlund EO, Von Holst H : Controlled subtotal evacuation of intracerebral haematomas by streotactic technique. Surg Neurol 9 : 99-101, 1978
  3. Batjer HH, Reisch JS, Allen BC, Plaizier LJ, Su CJ : Failure of surgery to improve outcome in hypertensive putaminal hemorrhage : a prospective randomized trial. Arch Neurol 47 : 1103-1106, 1990 https://doi.org/10.1001/archneur.1990.00530100071015
  4. Chambers IR, Banister K, Mendelow AD : Intracranial pressure within a developing intracerebral haemorrhage. Br J Neurosurg 15 : 140-141, 2001 https://doi.org/10.1080/02688690120036847
  5. Fayad PB, Awad IA : Surgery for intracerebral hemorrhage. Neurology 51 : S69-S73, 1998 https://doi.org/10.1212/WNL.51.3_Suppl_3.S69
  6. Findlay JM, Weir BK, Steinke D, Tanabe T, Gordon P, Grace M : Effect of intrathecal thrombolytic therapy on subarachnoid clot and chronic vasospasm in a primate model of SAH. J Neurosurg 69 723-735, 1988 https://doi.org/10.3171/jns.1988.69.5.0723
  7. Hankey GJ, Hon C : Surgery for primary intracerebral hemorrhage : is it safe and effective? A systematic review of cases and randomized trials. Stroke 28 : 2126-2132, 1997 https://doi.org/10.1161/01.STR.28.11.2126
  8. Hondo H, Uno M, Sasaki K, Ebisudani D, Shichijo F, Toth Z, et al : Computed tomography controlled aspiration surgery for hypertensive intracerebral hemorrhage : Experience of more than 400 cases. Stereotact Funct Neurosurg 54+55 : 432-437, 1990
  9. Jennett B, Bond M : Assessment of outcome after severe brain damage : A practical scale. Lancet I : 480-484, 1975
  10. Jeong DK, Lee KH, Kim BH, Kim KJ, Kim YH, Bajpai V, et al : On-the-fly generation of multiplanar reformation images independent of CT scanner type. J Digit Imaging : Epub ahead of print, 2007
  11. Kaneko M, Tanaka K, Shimada T, Sato K, Uemura K : Long-term evaluation of ultra-early operation for hypertensive intracerebral hemorrhage in 100 cases. J Neurosurg 58 : 838-842, 1983 https://doi.org/10.3171/jns.1983.58.6.0838
  12. Kingman TA, Mendelow AD, Graham DI, Teasdale GM : Experimental intracerebral mass : description of model, intracranial pressure changes and neuropathology. J Neuropathol Exp Neurol 47 : 128-137, 1988 https://doi.org/10.1097/00005072-198803000-00005
  13. Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, et al : The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27 : 1304-1305, 1996 https://doi.org/10.1161/01.STR.27.8.1304
  14. Lopez Valdes E, Hernandez Lain A, Calandre L, Grau M, Cabello A, Gomez Escalonilla C : Time window for clinical effectiveness of mass evacuation in a rat balloon model mimicking an intraparenchymatous hematoma. J Neurol Sci 174 : 40-46, 2000 https://doi.org/10.1016/S0022-510X(99)00288-9
  15. Marquardt G, Wolff R, Sager A, Hartung A, Lorenz R : Manual stereotactic aspiration of spontaneous deep-seated intracerebral haematomas in non-comatose patients. Br J Neurosurg 15 : 126-131, 2001 https://doi.org/10.1080/02688690120036810
  16. Morgenstern LB, Frankowski RF, Shedden P, Pasteur W, Grotta JC : Surgical treatment of intracerebral hemorrhage (STICH) : a singlecineter, randomized clinical trial. Neurology 51 : 1359-1363, 1998 https://doi.org/10.1212/WNL.51.5.1359
  17. Narayan RK, Narayan TM. Katz DA, Kornblith PL, Murano G : Lysis of intracranial hematomas with urokinase in a rabbit model. J Neurosurg 62 : 580-586, 1985 https://doi.org/10.3171/jns.1985.62.4.0580
  18. Nehls DG, Mendelow AD, Graham DI, Sinar EJ, Teasdale GM : Experimental intracerebral hemorrhage : progression of hemodynamic changes after production of a spontaneous mass lesion. Neurosurgery 23 : 439-444, 1988 https://doi.org/10.1227/00006123-198810000-00006
  19. Niizuma H, Otsuki T, Johkura H, Nakazato N, Suzuki J : CTguided stereotactic aspiration of intracerebral hematomas : results of a hematoma-lysis method using urokinase. Appl Neurophysiol 48 : 427-430, 1985
  20. Rohde V, Rohed I, Thiex R, Ince A, Duckers G, Groschel K, et al : Fibrinolysis therapy achieved with tissue plasminogen activator and aspiration of the liquefied clot after experimental intracerebral hemorrhage : rapid reduction in hematoma volume bur intensification of delayed edema formation. J Neurosurg 97 : 954-962, 2002 https://doi.org/10.3171/jns.2002.97.4.0954
  21. Schaller C, Rohde V, Meyer B, Hassler W : Stereotactic puncture and lysis of spontaneous hemorrhage using recombinant tissue plasminogen activator. Neurosurgery 36 : 328-335, 1995 https://doi.org/10.1227/00006123-199502000-00012

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