The experience of intrathecal fibrinolysis in surgery of massive intraventricular hemorrhage

Abstract

Introduction. Intraventricular hemorrhage (IVH) was detected in 30% patients with hypertensive intracerebral hemorrhages, that significantly worsens disease prognosis and course. Lethality is particularly high at massive IVH. Methods. 29 patients with massive IVH were operated (severity of the patient’s condition according to Graeb scale 7–10 scores), level of consciousness at the time of operation according to Glasgow Coma Scale (GCS) 8 scores and lower. All patients were operated on the 1 st –2 nd day of the disease, on the 1 st day after hospitalization. For intrathecal fibrinolysis Actylise in doze 3,5 mg was used, it was introduced into each intraventricular catheter, exposure 3 hours. The procedure was repeated 4 times during 24 hours (every 6 hours). Results. 17 (58,6%) patients were discharged from the clinic. 5 patients’ condition scored 4 on Glasgow Outcome Scale, 7 scored 3, five scored 2. Fibrinolytics are effective even in patients with complete tamponade of brain ventricular system, but patient’s initial GCS score has to be no lower than 6. Conclusions. Intrathecal fibrinolysis is a promising method for massive IVH treatment. It is ineffective in patients, been hospitalized in critical condition, with GCS score lower than 6, and Graeb score 9–10.