The Clinical Study of Stereotaxic Aspiration in Spontaneous Intraparenchymal Hematoma

Baek, Seoung Chan; Choi, Byung Yearn; Kim, Oh Lyong; Chi, Yong Chul; Cho, Soo Ho

Abstract

In a series of 91 patients underwent stereotaxic evacuation of spontaneous intraparenchymal hematoma during last 2 years; 15 had simple aspiration and 76 had urokinase irrigation gradually through the indwelling silastic catheter. Dosage of used urokinase was average 26,000u and duration was average 2.8 days. The average removed volume percent of the hematoma was 80.1+/-15.2%, eight out of 76 cases were performed urokinase irrigation revealed rebleeding; causes were overpressure during aspiration in 4 cases, blood dyscrasia in 3 cases, and fibrinolytic effect of urokinase in one case. High incidence of rebleeding were; thalamus(4 out of 16 cases; 25%) in location, before 6 hours(4 out of 19 cases; 21.1%) in operation time interval from ictus, below 10ml(4 out of 13 cases; 30.8%) in volume of the hematoma, but not correlated with amount of used urokinase. Causes of unsatisfactory removed cases were small hematoma, brain stem and thalamic hemorrhage and malposition of the catheter. Even in cases of combined ventricular hemorrhage, we didn't experienced hydrocephalus with urokinase irrigation. In 20 cases sampled randomly, osmolality of serum and aspirated liquefied hematoma were compared; the serum osmolality was 297.6+/-12mEq and osmolality of liquefied hematoma induced by urokinase was 304.7+/-11.3mEq. These findings strongly suggest that the surrounding interstitial fluid of the hematoma was shifted into the liquefied hematoma because of 7mEq difference of osmotic pressure. Over all good result(daily living activity) on discharge was 64.5% and mortality rate was 7.9%.