REMOVAL OF HYPERTENSIVE INTRACEREBRAL HEMATOMAS: A PUNCTURE-ASPIRATION METHOD WITH USE OF LOCAL FIBRINOLYSIS BY PROUROKINASE
A.S. Saribekyan, L.N. Polyakova, E.V. Arzamastsev, V.L. Golubykh
Department of Emergency Neurosurgery of Sklifosovsky Research Institute of Emergency Care, Department of Neurosurgery of Municipal Clinical Hospital N 15, Laboratory of Medicinal Toxicology of the Russian Academy of Medical Sciences
Operations were performed in 30 patients with hemorrhagic stroke. There were 5 medial hematomas, 6 hematomas of a mixed type, 16 lateral hematomas and 3 lobar hematomas. Their volume varied from 20 up to 60 cm3. Distribution of hematomas according to their volume was as follows: 20-30 cm3 - 2 patients, 31-40 cm3 – 13 cases, 41-50 cm3 - 7 patients, 51-60 cm3 - 8 cases. Bleeding into ventricles of the brain was diagnosed in 10 patients. Sopor and superficial coma were observed in 12, 11 and 1 cases respectively. There were no consciousness disturbances in 6 patients. Marked neurologic disorders (hemiplegia, severe paresis, oculomotor disturbances) were present in all cases. Aphasia was watched in 6 patients. Diagnosis was carried out with the help of CT(17 patients) and MRI (13 cases). These methods were used both before and after the operation.
The operation was performed as follows. Hematoma coordinated obtained by means of CT and MRI were plotted on a head of a patient. A burr hole was made in hematoma projection. This was followed by its puncture, aspiration of its content and insertion of a silicone catheter with a diameter of 1.5 mm. The puncture of hematoma was performed under control of ultrasonic scanning in 20 observations.
Prourokinase solution (3-5 ml) was administered fractionally into the cavity of hematoma through the catheter. It was done during the 1st-2nd day after the operation with the purpose of lysis of dense remnants of hematoma. Then they were aspirated by a syringe through the catheter. Dynamic control of removal efficacy by CT and MRI was carried out. Operation terms varied from 2 up to 8 days since the moment of stroke.
This method allowed to aspirate 65-90% of hematoma’s initial volume (80% on the average). Complete restoration was seen in 5 patients; satisfactory and bad results were observed in 10 and 2 cases respectively; 13 patients died. There were no repeated hemorrhages and inflammatory complications.