title: Local Fibrinolysis in Spontaneous Supratentorial Hematomas: Comparison with Surgical and Medical Treatment.
abstract: OBJECTIVE
  To evaluate the effectiveness of minimally invasive craniopuncture with local fibrinolysis in the management of supratentorial spontaneous intracerebral hemorrhage (SICH).
  
  
  METHODS
  The study included 218 consecutive patients with supratentorial SICH who were assigned to one of three groups: treated with minimally invasive craniopuncture with local fibrinolysis, treated with craniotomy or other minimally invasive techniques without local fibrinolysis, or receiving conservative management alone.
  
  
  RESULTS
  Minimally invasive craniopuncture with local fibrinolysis was associated with a lower rate of assisted ventilation, a shorter period of in-hospital stay, a more frequent initiation of early rehabilitation, and a lower mortality rate at all periods of assessment. The overall mortality at 12 months was 19.4% (vs. 50.0 and 33.3% in the two other therapy groups). Lobar (subcortical and cortical) SICHs treated with local fibrinolysis had an overall mortality of 4.8% (vs. 43.5 and 41.7% in the two other therapy groups). On the other hand, SICHs having mixed (basal ganglia and lobar) locations treated with medical therapy alone had an overall mortality of 28.6%, while associated surgery with or without local fibrinolysis increased the overall mortality to over 65%.
  
  
  CONCLUSIONS
  The study demonstrated the applicability of minimally invasive craniopuncture with local fibrinolysis for the management of supratentorial SICHs and the advantages it may have in certain categories of patients. The method proved particularly useful in lobar SICHs, being associated with the lowest mortality. Mixed SICHs do not represent a predilection for surgical interventions; however, the results related to mixed supratentorial locations need confirmation in larger cohorts.
authors: Institute of Neurology and Neurosurgery, Chisinau, Republic of Moldova.
authors: Eugeniu
authors: E
authors: Condrea
authors: Institute of Neurology and Neurosurgery, Chisinau, Republic of Moldova.
authors: Valeriu
authors: V
authors: Timirgaz
authors: Department of Neurology and Neurosurgery, Institute of Emergency Medicine, Chisinau, Republic of Moldova.
authors: Stanislav
authors: S
authors: Groppa
authors: Department of Radiology and Medical Imaging, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.
authors: Ion
authors: I
authors: Codreanu
authors: Department of Radiology and Medical Imaging, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.
authors: Natalia
authors: N
authors: Rotaru
keywords: Conservative management; Craniopuncture; Craniotomy; Local fibrinolysis; Minimally invasive surgery; Supratentorial spontaneous intracerebral hemorrhage