Further Experience of Stereotaxic Urokinase Treatment in Spontaneous Intracerebral Hematoma

Cho, Kyung Kun; Lee, Il Woo; Jo, Tae Hoon; Kim, Moon Chan; Kang, Joon Ki; Song, Jin Un

Abstract

According to the general principle that a surgical procedure should be as atraumatic as possible several authors proposed stereotaxic urokinase treatment in spontaneous intracerebral hematomas. Authors presented 29 cases of spontaneous intracerebral hematomas which were managed with stereotaxic urokinase treatment including 10 cases of preliminary report on Journal of Korean Neurosurgical Society June 1986. 19 cases were basal ganglia hematomas with or without ventricular rupture, 4 cases were thalamic hematomas with ventricular rupture, 3 cases were subcortical hematomas and 3 cases were intraventricular hematomas. The outcome of the treatment was analysed by the location and amount of hematomas, and the degree of disability of patient on admission and discharge. The outcome was worst in thalamic hematomas than putaminal or subcortical hematomas, and poorer as the amount of hematoma increased. The outcome was bad also in the patient who showed poor neurologic condition on admission. Time requiring hematoma dissapperance with urokinase treatment was estimated by the short term follow up CT scanning. All of the patient except moribund cases showed complete disappearance of hematomas within 10 days after treatment, and mean period was 6.7 days. Rebleeding after the urokinase treatment was noted in 4 cases, which was 2 putaminal, one thalamic and one ventricular hematoma. The cause of rebleeding might be mechanical injury of catheter insertion or too strong negative pressure on aspiration. But in 1 case of intraventricular hematoma, the possible causative factor should be anticoagulant effect of urokinase on the injured vessel. With above result, we concluded that this procedure may be better and safer than conventional craniotomy especially in cases of high risky or elderly patient with deep seated intracerebral hematomas. But the efficacy and safety must be studied further with the exact experimental model of spontaneous intracerebral hematomas.