Abstract
More than 70% of hypertensive hemorrhages are located in deep brain structures. The removal of such hematomas using encephalotomy is accompanied by additional cerebral trauma and often results in unsatisfactory outcomes. The puncture aspiration with local fibrinolysis is one of the minimal invasive methods for treatment of intracerebral hematomas (ICH). The puncture and aspiration of liquid part of ICH (not more than 20% of ICH volume) is performed via small burr hole. Afterward the catheter is placed into ICH cavity and fibrinolytic is injected via this catheter in postoperative period for lysis of ICH solid part. The lysed blood is aspirated within 1-4 days. The last generations of fibrinolytics are very effective concerning intensity of blood clot lysis and practically have no systematic effect on blood coagulation system during their local usage. Morphological examinations showed that usage of fibrinolysis leads to formation of smaller cysts in the region of former hematoma as well as reparative processes in perihemorrhagical zone are expressed better comparing with treatment methods without usage of fibrinolytics. The morphological pattern is also confirmed by clinical signs of neurological deficit regress corresponding to damage focus. We operated 124 patients with parenchymal hemorrhages and 28 patients with intraventricular hemorrhages using described minimally invasive method at the base of Scientific Research Institute of Emergency Care n.a. N. V. Sklifosovsky. The applied method allowed decreasing lethality from 35% to 21% among patients with parenchymal ICH and from 98% to 48%--among patients with ventricular hemotamponade underwent usage of ventricular drainage combined with local fibrinolysis.
Highlights
Развитие и внедрение в нейрохирургию современных методов диагностики и новых хирургических технологий позволило существенно пересмотреть идеологию хирургических вмешательств при нетравматических внутричерепных кровоизлияниях
More than 70% of hypertensive hemorrhages are located in deep brain structures
The removal of such hematomas using encephalotomy is accompanied by additional cerebral trauma and often results in unsatisfactory outcomes
Summary
Метод локального фибринолиза в хирургии нетравматических внутричерепных кровоизлияний. Одним из малотравматичных методов эвакуации внутримозговых гематом (ВМГ) является пункционная аспирация и локальный фибринолиз. Через небольшое трепанационное отверстие ВМГ пунктируют и аспирируют жидкую часть, которая составляет не более 20%. The puncture aspiration with local fibrinolysis is one of the minimal invasive methods for treatment of intracerebral hematomas (ICH). Morphological examinations showed that usage of fibrinolysis leads to formation of smaller cysts in the region of former hematoma as well as reparative processes in perihemorrhagical zone are expressed better comparing with treatment methods without usage of fibrinolytics. The applied method allowed decreasing lethality from 35% to 21% among patients with parenchymal ICH and from 98% to 48% — among patients with ventricular hemotamponade underwent usage of ventricular drainage combined with local fibrinolysis. Одним из перспективных направлений миниинвазивной хирургии геморрагического инсульта является метод пункционной аспирации и локального фибринолиза кровоизлияний [1]. Кальный фибринолиз при субарахноидальных и внутрижелудочковых кровоизлияниях (ВЖК) нетравматического генеза [10,11,12,13,14,15]
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