Acta Neurochirurgica

, Volume 127, Issue 3–4, pp 157–160 | Cite as

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

  • B. E. Lippitz
  • L. Mayfrank
  • U. Spetzger
  • J. P. Warnke
  • H. Bertalanffy
  • J. M. Gilsbach
Clinical Articles


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.


Intracerebral haematoma basal ganglia haematoma stereotactic aspiration rtPA instillation results 


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  1. 1.
    Backlund EO, Holst H (1978) Controlled subtotal evacuation of intracerebral haematomas by stereotactic technique. Surg Neurol 9: 99–101PubMedGoogle Scholar
  2. 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): 927–934PubMedGoogle Scholar
  3. 3.
    Etou A, Mohadjer M, Braus D, Mundinger F (1990) Stereotactic evacuation and fibrinolysis of cerebellar haematomas. Stereotact Funct Neurosurg 54 and 55: 445–450PubMedGoogle Scholar
  4. 4.
    Findlay JM, Weir BKA, Stollery DA (1991) Lysis of intraventricular haematoma with tissue plasminogen activator. J Neurosurg 74: 803–807PubMedGoogle Scholar
  5. 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: 432–437PubMedGoogle Scholar
  6. 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. 7.
    Kanaya H, Endo H (1984) Surgical treatment and results of surgery for hypertensive intracerebral haemorrhage. No To Shinkei 36: 847–857 (Japanese)PubMedGoogle Scholar
  8. 8.
    Kandel EI, Peresedov W (1990) Stereotactic evacuation of spontaneous intracerebral haematomas. Stereotact Funct Neurosurg 54 and 55: 427–431PubMedGoogle Scholar
  9. 9.
    Kaufman HH, Schochet S, Koss W, Herschberger J, Bernstein D (1987) Efficacy and safety of tissue plaminogen activator. Neurosurgery 20: 403–407PubMedGoogle Scholar
  10. 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: 451–452PubMedGoogle Scholar
  11. 11.
    Lunsford LD (1989) Comment. Neurosurgery 24: 819Google Scholar
  12. 12.
    Matsumoto K, Hondo H (1984) CT-guided stereotaxic evacuation of hypertensive intracerebral haematomas. J Neurosurg 61: 440–448PubMedGoogle Scholar
  13. 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: 32–38Google Scholar
  14. 14.
    Mohadjer M, Braus DF, Myers A, Scheremet R, Krauss JK (1992) CT-stereotactic fibrinolysis of spontaneous intracerebral haematomas. Neurosurg Rev 15: 105–110PubMedGoogle Scholar
  15. 15.
    Niizuma H, Shimizu Y, Yonemitsu T, Nakasato N, Suzuki J (1989) Results of stereotactic aspiration in 175 cases of putaminal haemorrhage. Neurosurgery 24: 814–819PubMedGoogle Scholar
  16. 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: 438–444PubMedGoogle Scholar
  17. 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: 877–881PubMedGoogle Scholar
  18. 18.
    Takasugi S, Ueda S, Matsumoto K (1985) Chronological changes in spontaneous intracerebral haematoma: an experimental and clinical study. Stroke 16: 651–658PubMedGoogle Scholar
  19. 19.
    Tanizaki Y (1988) Improvement of cerebral blood flow following stereotactic surgery in patients with putaminal haemorrhage. Acta Neurochir (Wien) 90: 103–110Google Scholar
  20. 20.
    Waga S, Miyazaki M, Okada M, Tochio H, Matsushima S, Tanaka Y (1986) Hypertensive putaminal haemorrhage: analysis of 182 patients. Surg Neurol 26: 159–166PubMedGoogle Scholar
  21. 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]: 45–48Google Scholar
  22. 22.
    Yamanaka R, Satoh S (1988) Comparison of stereotactic aspiration, craniotomy, and conservative treatment for putaminal haemorrhage. Neurol Med Chir (Tokyo) 28: 986–990Google Scholar
  23. 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. 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: 15–19PubMedGoogle Scholar
  25. 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: 421–426PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • B. E. Lippitz
    • 1
  • L. Mayfrank
    • 1
  • U. Spetzger
    • 1
  • J. P. Warnke
    • 1
  • H. Bertalanffy
    • 1
  • J. M. Gilsbach
    • 1
  1. 1.Department of Neurosurgery, Medical FacultyTechnical UniversityAachenFederal Republic of Germany

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