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Lysis of basal ganglia haematoma with recombinant tissue plasminogen activator (rtPA) after stereotactic aspiration: Initial results

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Summary

In a series of 10 patients with stereotactically treated basal ganglia haematoma rtPA was used to dissolve remaining clots.

Pre-operative haematoma volume ranged between 39 and 111 cm3 (average 56 cm3). Stereotactic aspiration alone yielded an average volume reduction of 60% (range 23 to 78%). Haematoma cavity was instillated with rtPA repeatedly beginning 24 hours after the stereotactic intervention. At the end of rtPA therapy between 2 and 4 days after onset of the haemorrhage 67 to 92% (average 84%) of the initial haematoma was removed in all patients. More than 80% of the pre-operative clot could be removed in 8 out of 10 patients between day 2 and 4. There were no signs of rtPA related toxicity. At the end of the follow-up period (between 4 and 17 months-mean 8 months) 6 patients were awake, oriented and with a residual hemiparesis able to live in their familiar environment.

It is concluded that local rtPA instillation is an effective additional treatment to further resolution of deep seated intracerebral haematomas after stereotactic aspiration.

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References

  1. Backlund EO, Holst H (1978) Controlled subtotal evacuation of intracerebral haematomas by stereotactic technique. Surg Neurol 9: 99–101

    PubMed  Google Scholar 

  2. Ebina K, Okabe S, Manabe H, Iwabuchi T (1990) Experimental study on liquefaction of intracranial haematomas: usefulness of tissue plasminogen activator (t-PA), a haematolytic agent, and its combination. No Shinkei Geka 18 (10): 927–934

    PubMed  Google Scholar 

  3. Etou A, Mohadjer M, Braus D, Mundinger F (1990) Stereotactic evacuation and fibrinolysis of cerebellar haematomas. Stereotact Funct Neurosurg 54 and 55: 445–450

    PubMed  Google Scholar 

  4. Findlay JM, Weir BKA, Stollery DA (1991) Lysis of intraventricular haematoma with tissue plasminogen activator. J Neurosurg 74: 803–807

    PubMed  Google Scholar 

  5. Hondo H, Uno M, Sasaki K, Ebisudani D, Shichijo F, Toth Z, Matsumoto K (1990) Computed tomography controlled aspiration surgery for hypertensive intracerebral haemorrhage: experience of more than 400 cases. Stereotact Funct Neurosurg 54 and 55: 432–437

    PubMed  Google Scholar 

  6. Ishii R, Takeuchi S, Ohsugi S, Tanaka R, Arai H (1982) Cerebral blood flow in patients with putaminal haemorrhage. Using 133Xe inhalation method. Neurol Med Chir (Tokyo) 22: 813–821 (Japanese)

    Google Scholar 

  7. Kanaya H, Endo H (1984) Surgical treatment and results of surgery for hypertensive intracerebral haemorrhage. No To Shinkei 36: 847–857 (Japanese)

    PubMed  Google Scholar 

  8. Kandel EI, Peresedov W (1990) Stereotactic evacuation of spontaneous intracerebral haematomas. Stereotact Funct Neurosurg 54 and 55: 427–431

    PubMed  Google Scholar 

  9. Kaufman HH, Schochet S, Koss W, Herschberger J, Bernstein D (1987) Efficacy and safety of tissue plaminogen activator. Neurosurgery 20: 403–407

    PubMed  Google Scholar 

  10. Liu Zh, Kang GQ, Chen XH, Tian ZM, Cai HZ, Zhang Y, Li SY (1990) Evacuation of hypertensive intracerebral haematoma by a stereotactic technique. Stereotact Funct Neurosurg 54 and 55: 451–452

    PubMed  Google Scholar 

  11. Lunsford LD (1989) Comment. Neurosurgery 24: 819

    Google Scholar 

  12. Matsumoto K, Hondo H (1984) CT-guided stereotaxic evacuation of hypertensive intracerebral haematomas. J Neurosurg 61: 440–448

    PubMed  Google Scholar 

  13. Mayfrank L, Lippitz B, Groth M, Bertalanffy H, Gilsbach JM (1993) Effect of recombinant tissue plasminogen activator on clot lysis and ventricular dilatation in the treatment of severe intraventricular haemorrhage. Acta Neurochir (Wien) 122: 32–38

    Google Scholar 

  14. Mohadjer M, Braus DF, Myers A, Scheremet R, Krauss JK (1992) CT-stereotactic fibrinolysis of spontaneous intracerebral haematomas. Neurosurg Rev 15: 105–110

    PubMed  Google Scholar 

  15. Niizuma H, Shimizu Y, Yonemitsu T, Nakasato N, Suzuki J (1989) Results of stereotactic aspiration in 175 cases of putaminal haemorrhage. Neurosurgery 24: 814–819

    PubMed  Google Scholar 

  16. Niizuma H, Yonemitsu T, Jokura H, Nakasato N, Suzuki J, Yoshimoto T (1990) Stereotactic aspiration of thalamic haematoma: overall results of 75 aspirated and 70 non-aspirated cases. Stereotact Funct Neurosurg 54 and 55: 438–444

    PubMed  Google Scholar 

  17. Stolke D, Seifert V (1992) Single intracisternal bolus of recombinant tissue plasminogen activator in patients with aneurysmal subarachnoid haemorrhage: preliminary assessment of efficacy and safety in an open clinical study. Neurosurgery 30: 877–881

    PubMed  Google Scholar 

  18. Takasugi S, Ueda S, Matsumoto K (1985) Chronological changes in spontaneous intracerebral haematoma: an experimental and clinical study. Stroke 16: 651–658

    PubMed  Google Scholar 

  19. Tanizaki Y (1988) Improvement of cerebral blood flow following stereotactic surgery in patients with putaminal haemorrhage. Acta Neurochir (Wien) 90: 103–110

    Google Scholar 

  20. Waga S, Miyazaki M, Okada M, Tochio H, Matsushima S, Tanaka Y (1986) Hypertensive putaminal haemorrhage: analysis of 182 patients. Surg Neurol 26: 159–166

    PubMed  Google Scholar 

  21. Yague L, Garcia-March G, Paniagua C, Sanchez-Ledesma MJ, Diaz P, Ludena D, Maillo A, Broseta J (1987) Stereotactic evacuation and local administration in intracerebral haematomas. A comparative study. Acta Neurochir (Wien) [Suppl 39]: 45–48

    Google Scholar 

  22. Yamanaka R, Satoh S (1988) Comparison of stereotactic aspiration, craniotomy, and conservative treatment for putaminal haemorrhage. Neurol Med Chir (Tokyo) 28: 986–990

    Google Scholar 

  23. Yamanaka R, Satoh S (1988) Analysis of intra- and postoperative recurrent bleeding in cases of stereotactic haematoma aspiration. No Socchu 10: 54–59 (Japanese)

    Google Scholar 

  24. Yamanaka R, Satoh S (1989) Cerebral blood flow in patients with putaminal haemorrhage after stereotactic aspiration or conservative treatment. Neurol Med Chir Tokyo 29: 15–19

    PubMed  Google Scholar 

  25. Yokote H, Komai N, Nakai E, Ueno M, Hayashi S, Terashita T (1989) Stereotactic evacuation of hypertensive cerebellar haemorrhage using plasminogen activator. No Shinkei Geka 17: 421–426

    PubMed  Google Scholar 

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Lippitz, B.E., Mayfrank, L., Spetzger, U. et al. Lysis of basal ganglia haematoma with recombinant tissue plasminogen activator (rtPA) after stereotactic aspiration: Initial results. Acta neurochir 127, 157–160 (1994). https://doi.org/10.1007/BF01808759

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