Minimum-Invasive Treatment of Traumatic Intracerebral Hematomas with Puncture Aspiration and Local Fibrinolysis

Burov S.A., Dashyan V.G., Talipov A.E., Krilov V.V.

Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
Moscow State Medical-Stomatologic University, Moscow, Russia

 

The goal has been studying possibility of removal of traumatic intracerebral hematomas, located in different areas, using local fibrinolysis with recombinant prourokinase in compensated cases (the Glasgow Coma score of 13 and more).

Material and Methods. Fibrinolysis was used as a method of removal of traumatic hematomas in 46 casualties (10 females and 36 males), aged 18-67. Epidural, subdural and intracerebral hematomas were revealed in 11, 20 and 12 cases, respectively. There were 3 cases, operated for multiple hematomas. A hemorrhage volume varied from 18 up to 97 cm3. Operation consisted in drainage of intracerebral hematoma with a catheter (1.4 or 1.2 mm). It was done through a burr hole and followed by administration of fibrinolytic drugs into a hemorrhagic cavity with an interval of six hours and subsequent aspiration of a fluid portion of blood. Fibrinolysis was accompanied by estimating dynamics of a neurological state and a hematoma volume, based on CT data and intracranial pressure indices.

Results. Complete removal of intracerebral hematomas (more than 95% of their initial volume) with regression of clinical symptoms was achieved in 37 (84%) out of 46 cases. Hemorrhage recurrences, demanding repeated operation, were watched in 4 cases (10%) with epidural hematomas. There were 4 fatal outcomes (10%), caused by complications, which were not connected with the main disease.

Conclusion. Local fibrinolysis can be used as an alternative minimum-invasive method for removal of traumatic hematomas in compensated cases or at an initial stage of dislocation syndrome decompensation.