Intrathecal Fibrinolysis in Massive Non-Traumatic Intraventricular Hemorrhages

Burov S.*, Dashyan V.*, Krilov V.**

* Moscow State Medical Stomatological University, Moscow, Russia;
** Sklifosovsky Research Institute of Emergency care, Moscow, Russia


The research goal was to study an effect of intrathecal fibrinolysis on clot lysis velocity and resolution of occlusive hydrocephalus in massive non-traumatic intraventricular hemorrhages (MIVH).

Material and Methods. There were 34 cases (19 males and 15 females) with MIVH, aged 15-62, who underwent surgical treatment. Severity of their state was characterized by a score of 8-5 (the Glasgow Coma Scale). Intrathecal fibrinolysis with streptokinase and purolase was carried out during the first three days in 22 of them; the rest 12 patients were subject to external ventricular drainage without fibrinolytics (a control group).

Results. External ventricular drainage turned out to be ineffective as a means of resolution of occlusive hydrocephalus due to quick obstruction of drains by blood clots. It led to fatal outcomes, caused by occlusive hydrocephalus on the 6th post-hemorrhagic day on the average. Fibrinolysis made it possible to improve a state of the ventricular system on the 3rd day after hemorrhage (a mean period). According to CT data and 70% reduction of hemorrhage intensity, occlusive hydrocephalus resolved in all the cases of the main group. Repeated hemorrhage was watched during fibrinolysis in 3 patients (14%). It did not exceed the rate of repeated hemorrhages from aneurysms in an acute period of the disease natural course. In spite of an extremely severe state of the cases, mortality reduced up to 70% as compared with 98%, typical of the control group.

Conclusion. Intrathecal fibrinolysis promotes effective and very quick improvement of a liquor state and restoration of its circulation with resolution of hydrocephalus during the first three days after SAH. Besides, it does not result in a higher rate of hemorrhagic complications.