CT-guided stereotactic fibrinolysis of spontaneous and hypertensive cerebellar hemorrhage: long-term results.
The surgical indication for spontaneous cerebellar hemorrhage is not as controversial as the operative management of intracranial hemorrhage. Timing of the operation is crucial: intervening too early can produce an additional strain on the patient and an increased risk, while waiting too long to evacuate the hematoma can be fatal. This dilemma may be a factor in the relatively high mortality and morbidity rates following both operative and conservative treatment that have been reported in the literature (42.5% and 30%, respectively). In long-term studies on 14 patients, the authors have shown that stereotactic puncture and fibrinolysis for cerebellar hemorrhage is a valuable alternative to treatments used currently. The method consists of computerized tomography (CT)-guided stereotactic puncture and partial evacuation of the hematoma. After fibrinolysis with urokinase, the residual hematoma can be completely evacuated via a catheter introduced into the cavity of the hematoma. Only one of the 14 patients died in the direct postoperative phase; the remaining patients were enjoying a good to very good quality of life 6 months after the acute event. Two patients subsequently died as a result of pneumonia and cerebral infarction, respectively; both conditions were unrelated to the hemorrhage. The authors conclude that the CT-guided stereotactic method is simple, effective, and safe, and can be applied to patients of any age.
Department of Stereotactic Neurosurgery, University of Freiburg Medical School, Federal Republic of Germany.
M
M
Mohadjer
R
R
Eggert
J
J
May
L
L
Mayfrank
D000328:Adult; D000368:Aged; D000818:Animals; D002526:Cerebellar Diseases / Q000188:drug therapy* / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000188:drug therapy* / Q000601:surgery; D004195:Disease Models, Animal; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D051381:Rats; D011919:Rats, Inbred Strains; D013238:Stereotaxic Techniques; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D014568:Urokinase-Type Plasminogen Activator