Hematoma Puncture Research Articles

Computed Tomography-Guided Virtual Stereotactic Puncture and Catheter Drainage for a Brainstem Pontine Hemorrhage: A Case Report

Background: Patients with severe hypertensive brainstem hemorrhages have poor prognoses if they only receive conservative medical management. In contrast, aggressive operative interventions may decrease the morbidity and mortality in such patients. These operative treatments include craniotomy for evacuation of the hematoma, stereotactic positioning, and neuronavigational-guided hemorrhage puncture and drainage. Here, we report a novel and relatively simple procedure to achieve satisfactory outcomes in a patient with a brainstem pontine hemorrhage. Case Presentation: A 53-year-old man who was diagnosed with brainstem pontine hemorrhage. On hospital day 6, he underwent CT-guided, virtual stereotactic puncture and catheter drainage of this brainstem pontine hemorrhage. Medical treatments were continued after this procedure. On postoperative day 16 (hospital day 22), the patient was discharged from the hospital, awake and able to answer questions appropriately. Muscle strengths were grades V and IV for the left and right extremities, respectively. The patient was continued with active rehabilitation and achieved a Barthel index of 85 points at one month after the percutaneous drainage procedure. Conclusion: CT-guided, virtual stereotactic percutaneous transcranial puncture and catheter drainage for brainstem pontine hemorrhages has obvious potential advantages and offers a possible alternative to achieve the best outcomes with minimal operative trauma compared to open microcraniotomy.

Endoscopic surgery for thalamic hemorrhage breaking into ventricles: Comparison of endoscopic surgery, minimally invasive hematoma puncture, and external ventricular drainage

PurposeThalamic hemorrhage breaking into ventricles (THBIV) is a devastating disease with high morbidity and mortality rates. Endoscopic surgery (ES) may improve outcomes, although there is no consensus on its superiority. We investigated the efficacy and safety of ES and compared the outcomes of different management strategies by ES, hematoma puncture and drainage (HPD), and external ventricular drainage (EVD) in patients with THBIV. MethodsWe retrospectively analyzed patients with THBIV treated by ES, HPD, or EVD at our hospital from June 2015 to June 2018. Patients were categorized into anteromedial and posterolateral groups based on THBIV location, and then the two groups were further divided into ES, HPD, and EVD subgroups. Individualized surgical approach was adopted according to the location of the hematoma in the ES subgroups. Patient characteristics and surgical outcomes were investigated. ResultsWe analyzed 211 consecutive patients. There were no significant differences in clinical characteristics or incidence of perioperative procedure-related complications (postoperative rebleeding and intracranial infection) in either anteromedial or posterolateral groups. Compared with other therapeutic methods, the ES subgroups had the highest hematoma evacuation rate, shortest drainage time, and lowest incidence of chronic ventricular dilatation (all p < 0.05). Among the three anteromedial subgroups, ES subgroup had the best clinical outcomes which was assessed by the modified Rankin Scale, followed by HPD and EVD subgroups (p < 0.01); while in the posterolateral subgroups, clinical outcomes in the ES and HPD subgroups were similar and better than that in the EVD subgroup (p = 0.037). ConclusionIndividualized surgical ES approach for removal of thalamic and ventricular hematomas is a minimally invasive, safe, and effective strategy for the treatment of THBIV with a thalamic hematoma volume of 10–30 mL.

Application of a 3D-Printed Navigation Mold in Puncture Drainage for Brainstem Hemorrhage

BackgroundBrainstem hemorrhage is an acute and severe neurosurgical disease. Cerebral hemorrhage is surgically treated via hematoma puncture drainage because of its minimally invasive nature. However, the placement of puncture must be extremely accurate due to the special anatomical location of the brainstem and its physiological functions. The present study aimed to evaluate whether the application of a three-dimensional (3D)-printed navigation mold achieved good outcomes in the surgical treatment of brainstem hemorrhage. Material and methodsThe present study included seven patients (three men and four women aged 40-56 y) who underwent 3D print–assisted hematoma puncture drainage between June 2016 and March 2018 at Binzhou Medical University Hospital. The amount of brainstem hemorrhage was 15-47 mL. We analyzed the basic surgical conditions, deviation distance, and postoperative clinical improvement. ResultsIn all cases, the operation was completed successfully; no patient died or contracted an infection intraoperatively. The end of the puncture tube was located in the hematoma cavity in all cases. The deviation distance ranged from 2.5 to 7.2, and this distance gradually reduced with improvements in the technique. The hematoma drainage achieved satisfactory postoperative outcomes, with improvements in symptoms such as respiratory failure and hyperthermia. ConclusionsUse of a 3D-printed navigation mold for puncture drainage of brainstem hemorrhage realized the purpose of individualized and precision medicine, which is important in maintaining the vital signs of patients with severe brainstem hemorrhage.

A Novel Simple Puncture Positioning and Guidance System for Intracerebral Hematoma

Minimally invasive surgical techniques may have beneficial effects on spontaneous intracerebral hemorrhage. Accurate localization of the hematoma and real-time guided puncture are more important in minimally invasive surgical procedures than in traditional craniotomy. Here, we introduce a novel simple puncture positioning and guidance system for intracerebral hematoma and demonstrate its utility for hematoma puncture surgery in a simulation experiment and series of patients. We describe the device and use of the technique for hematoma puncture surgery in basal ganglia hematomas and report on the precision of the simulation experiments compared to that of freehand puncture, as well as its clinical application in 16 cases. The accuracy of this technique was superior to that of freehand puncture. All 16 patients underwent successful puncturing of the hematoma cavity or ventricles only once without any related complications. We demonstrate a novel simple puncture positioning and guidance system that has the advantages of simplicity, low-cost, device availability, and individual real-time guidance. We believe this system may be useful in resource-limited centers where navigation is not available.

Stereotactic treatment of hypertensive intracerebral hemorrhage in basal ganglia region

Objective To evaluate the efficacy of stereotactic hematoma evacuation surgery for hypertensive cerebral hemorrhage in basal ganglia region. Methods A retrospective analysis was performed on 65 cases of hypertensive cerebral hemorrhage in the basal ganglia from August 2015 to March 2018 at the Stereotactic and Neurofunctional Center of the 306th Hospital of PLA. According to different surgical methods, those patients were divided into 2 groups. In the hematoma puncture group, 35 patients underwent hematoma puncture and drainage surgery; in the stereotaxis group, 30 patients underwent stereotactic puncture and catheter drainage surgery assisted by robot Remebot. The baseline conditions, bleeding time, volume of hematoma, preoperative GCS (Glasgow coma scale) score, Barthel score before discharge and at 3 months post operation, and the time of thorough hematoma drainage were compared between the 2 groups. Results (1) The time for thorough hematoma drainage in the stereotaxis group was significantly less than that in the hematoma puncture group. There was a significant difference between the 2 groups (Z=3.69, P<0.01). (2) Barthel scores before discharge (89.7±7.2) and at 3 months post operation (94.0±5.7) in stereotaxis group were significantly higher than those in hematoma puncture group (before discharge: 75.3±7.2, 3 months post operation: 76.4±8.2, both P<0.01). Conclusion Stereotactic hematoma evacuation surgery could significantly accelerate the removal time of hematoma in patients with hypertensive intracerebral hemorrhage, quickly relieve the compression of brain tissue by hematoma and promote the recovery of neurological function. Key words: Intracranial hemorrhage, hypertensive; Basal ganglia; Neurosurgical procedures; Stereotactic; Treatment outcome

Effect of early rehabilitation for basal ganglia hemorrhage patients treated with hematoma puncture and catheter drainage

Effect of early rehabilitation for basal ganglia hemorrhage patients treated with hematoma puncture and catheter drainage

The Clinical Efficacy of Electromagnetic Navigation-Guided Hematoma Puncture Drainage in Patients with Hypertensive Basal Ganglia Hemorrhage

To investigate the clinical efficacy of navigation-guided minimally invasive surgery in patients with hypertensive basal ganglia hemorrhage. A total of 64 patients with hypertensive basal ganglia hemorrhage were enrolled in this retrospective study. They were divided into a navigation group and a traditional group based on surgical approaches. The data for the 2 groups of patients were analyzed with regard for the hematoma clearance rate, duration of surgery, duration of hospitalization, Glasgow Outcome Scale score at discharge, Barthel index score at 6 months, and postoperative complication rates for rebleeding and pneumonia. There were no significant differences in basic characteristics between the 2 groups (P > 0.05). The hematoma clearance rate was significantly lower in the navigation group (49.18 ± 16.76%) than in the traditional group (84.29 ± 6.91%, P < 0.01). The duration of surgery and duration of hospitalization were significantly shorter in the navigation group (55.00 ± 11.89 minutes and 24.25 ± 7.1 days, respectively) than in the traditional group (156.38 ± 47.9 minutes and 32.63 ± 9.8 days, respectively; both P < 0.01). There were also significant differences between the 2 groups in Glasgow Outcome Scale scores (P= 0.006). The Barthel index scores were significantly greater in the navigation group (73.13 ± 18.76) than in the traditional group (57.63 ± 26.63, P < 0.05). There were no significant differences between the 2 groups in the complication rates (P > 0.05). Under certain conditions, compared with standard craniotomy and hematoma evacuation, navigation-guided hematoma puncture aspiration and catheter drainage is simple, effective, and safe as a treatment for hypertensive basal ganglia hemorrhage.

Comparison of effectiveness between two different modes of surgical intervention for the treatment of intracerebral hemorrhage in hypertensive patients

Objective To study the efficacy of two different modes of surgical intervention for the treatment of hypertensive intracerebral hemorrhage (HICH): YL-1 type hematoma removed by needle aspiration plus bio-enzyme liquefaction versus conventional craniectomy plus hematoma evacuation. Methods Medical records of 23 patients with HICH treated from December 2012 to February 2017 were retrospectively analyzed. The differences in demographics, length of operation time, costs and length of hospital stay, Glasgow Outcome Scale scores and 3-month follow-up results were compared between the YL-1 type hematoma removed by needle aspiration plus bio-enzyme liquefaction in 12 patients and conventional craniectomy plus hematoma evacuation in 11 patients. Results There were no significant differences in the gender (male 58.33% vs. 63.64%, femal 41.67% vs. 36.36%) , age (65.5±11.8 years vs. 56.8±10.1 years), preoperative GCS (6.83±3.93 vs. 5.82±3.40), intracranial hematoma volume (50.52±23.07 mL vs. 68.77±11.18 mL) and length of hospital stay (15.58±14.72 days vs. 22.45±18.37 days) (P>0.05); There were statistically significant differences in length of operation time (0.73±0.21 h vs. 3.92±0.67 h) and hospitalization costs (45 230.50±36 566.88 yuan of RMB vs. 79 857.90±34 916.48 yuan of RMB) between two groups (P 0.05). Conclusions The minimally invasive YL-1 type hematoma aspiration procedure with bio-enzyme liquefaction as a minimally invasive surgery may be superior to conventional craniectomy for treating HICH because it can offer shorter operation time, more accurate hematoma localization, lower risk of injury, and lower hospitalization costs. In particular, the procedure is suitable for elderly, frail, and poor general condition patients. It can also be applied as emergency treatment for HICH. Key words: Hypertensive intracerebral hemorrhage; Decompressive craniectomy; Minimally invasive surgery; YL -1 intracranial hematoma puncture needle therapy; Bio-enzyme liquefaction; Urokinase; Hematoma localization; Rehemorrhage

Complications of Cerebral Angiography Performed at a University Hospital

Objective: The risk of complication of cerebral angiography has always been the focus of attention. The aim of this study was to evaluate the outcome of cerebral angiography performed in the first 30 months of operational training in the endovascular neurosurgery service of a university hospital. Methods: A retrospective study evaluated 129 digital cerebral angiography examinations in 91 patients at a univeristy hospital from Southern Brazil. Results: The rate of complication was 2/129 (1.55%); of them, one (0.77%) presented a transient complication (hematoma puncture), and one (0.77%) a permanent complication with death of the patient because of an association between clotting in the middle cerebral artery and complications from the initial trauma. Conclusion: The rate of cerebral angiography complication obtained was low (1.75%) and underscores its reduced risk when performed in a neurological service even with professional in training.

Application of early time window modified stereotaxic aspiration in converting operation therapy on the specified acute epidural hematoma

Objective To discuss the application of early time window modified stereotaxic aspiration in converting operation therapy on the specified acute epidural hematoma. Methods 21 patients with the specified acute epidural hematoma were treated with early time window modified stereotaxic aspiration drainage, using YL-1 hematoma puncture needle with silica gel ventricular drainage tube. Results The successful rate of puncture was 100%.Hematoma was completely cleared in 19 cases.A small amount of epidural effusion was remained in 2 cases.1 case had concomitant rebleeding during the puncture, and shifted to craniotomy. Conclusion Early time window modified stereotaxic aspiration drainage is a minimally invasive, safe and effective treatment on the specified acute epidural hematoma when mastering the indications, timing and skills of puncture. Key words: Hematoma, epidural, cranial; Stereotaxic aspiration drainage

Analysis of the causes of postoperative bleeding in hypertensive intracerebral hemorrhage patients

Objective To explore the reasons for rebleeding and its coping strategies. Methods To study the 19 hypertensive intracerebral hemorrhage patients' medical records who suffered postoperative rebleeding in our department from June 2011 to May 2015. Results Rebleeding time: within 6 hours: 11 cases, 6~24 hours: 5 cases, 2~3 weeks: 3 cases.Among 19 cases, hematoma puncture drainage in 2 cases, small bone window craniotomy surgery in 9 cases, craniotomy with big bone flap decompression in 8 cases, 6 cases with severely disabled and 7 cases died. Conclusion Intraoperative bleeding operation is not standardized, early postoperative blood pressure control failure in patients, preoperative instability function are the main causes of postoperative bleeding.Choosing a better operating time, the specification intraoperative hemostasis and controlling blood pressure to stable after surgery can reduce the membership of hypertensive intracerebral hemorrhage incidence of postoperative bleeding. Key words: Cerebral hemorrhage; High blood pressure; Department of Neurosurgery operation; Rebleeding

Échographie des lésions musculaires

Ultrasound (US) combined with clinical imaging modality is the examination of choice in the investigating of muscle damage. This non-invasive, inexpensive and sensitive examination gives him a place of choice for the diagnosis, monitoring and therapeutic management of traumatic pathologies intrinsic or extrinsic muscle. Ultrasound can confirm clinical diagnosis and quantifies the extent of damage. US monitoring also ensures stabilization of injuries and, if appropriate, make hematoma puncture gestures.

Subdural Hematoma and Postdural Puncture Headache from Intrathecal Pump Placement Resolved with Lumbar Epidural Blood Patch

Intrathecal drug delivery systems are commonly used in the management of chronic pain, cancer pain and neuromuscular disorders with muscle spasticity. The complications associated with in-trathecal pump placement include persistent cerebrospinal fluid (CSF) leak, hygroma, meningitis, and granuloma formation. A severe persistent CSF leak may cause postdural puncture headache along with acute intracranial subdural hematoma, which can be potentially life threatening. Surgical exploration with dural repair is required to treat this severe complication when conservative treatments fail. We present a case report of severe persistent CSF leak after intrathecal pump revision that resulted in a subdural hematoma and postdural puncture headache. In this case, an epidural blood patch was performed using epidural catheter under fluoroscopic guidance to target the site of CSF leak and to avoid damaging the intrathecal catheter. This patient’s headache was resolved and intrathecal catheter remained intact after this blood patch.

Comparative analysis of four different treatments for hypertensive thalamic hemorrhage

One hundred and twenty patients with hypertensive thalamic hemorrhage were treated by different methods according to clinical situation and patients or family members. In this study 33 patients died: 7 patients were treated with conservative therapy, 6 patients with bilateral ventricle drainage, 8 patients with bilateral ventricle drainage plus hematoma puncture and aspiration, 12 patients with hematoma evacuation and decompressive cranioectomy. Comparison between different treatments revealed a statistically significant difference (P < 0.05). The treatment for hypertensive thalamic hemorrhage should be treated by different methods according to various clinical conditions to obtain better outcome. DOI：10.3969/j.issn.1672⁃6731.2012.04.020

A randomized study of urgent computed tomography–based hematoma puncture and aspiration in the emergency department and subsequent evacuation using craniectomy versus craniectomy only

When treating patients with a spontaneous supratentorial massive (≥ 70 ml) intracerebral hemorrhage (ICH), the results of surgery are gloomy. A worsening pupil response has been observed in patients preoperatively, despite blood pressure control and diuretic administration. Because open surgery needs time for decompression to occur, the authors conducted a prospective randomized study to determine whether patients who have suffered a massive ICH can benefit from a more urgently performed decompressive procedure. Overall, 36 eligible patients admitted 6 or fewer hours post-ictus were enrolled in the study. In Group A, 12 patients underwent CT-based hematoma puncture and partial aspiration in the emergency department (ED) and subsequent evacuation via a craniectomy; in Group B, 24 patients underwent hematoma evacuation via a craniectomy only. Pupil responses were categorized into 5 grades (Grade 0, bilaterally fixed; Grade 1, unilaterally fixed with the fixed pupil > 7 mm; Grade 2, unilaterally fixed with the fixed pupil ≤ 7 mm; Grade 3, a unilaterally sluggish response; and Grade 4, a bilaterally brisk response). Grades were obtained on admission, at surgical decompression (defined as the point at which liquid hematoma began to flow out in Group A and at dural opening in Group B), and at completion of craniectomy. The Barthel Scale was used to assess survivors' functional outcome at 12 months. Comparisons were made between Groups A and B. Logistic regression analysis was used to evaluate the positive likelihood ratio of all variables for survival and function (Barthel Scale score of ≥ 35 at 12 months). Decompressive surgery was undertaken approximately 60 minutes earlier in Group A than B. A worsening pupil reflex before decompression was observed in no Group A patient and in 9 Group B patients. At the time of decompression pupil response was better in Group A than B (p < 0.05). Although only approximately one-third of the hematoma volume documented on initial CT scanning had been drained before the craniectomy in Group A, when partial aspiration was followed by craniectomy, better pupil-response results were obtained in Group A at the completion of craniectomy, and survival rate and 12-month Barthel Scale score were better as well (p < 0.05). Logistic regression analysis revealed that one variable, a minimum pupil grade of 3 at the time of decompression, had the highest predictive value for survival at 12 months (8.0, 95% CI 2.0-32.0), and a pupil grade of 4 at the same time was the most valuable predictor of a Barthel Scale score of 35 or greater at 12 months (15.0, 95% CI 1.9-120.9). Patients with massive spontaneous supratentorial ICHs may benefit from more urgent surgical decompression. The results of logistic regression analysis implied that, to improve long-term functional outcome, decompression should be performed in patients before herniation occurs. Due to the fact that most of these patients have signs of herniation when presenting to the ED and because conventional surgical decompression requires time to take effect, this combination of surgical treatment provides a feasible and effective surgical option.

Early hematoma piercing attract combining with hematoma clearance to bone valves decompression technique to treat high blood pressure brain hemorrhage

Objective To explore hematoma piercing attract joint hematoma clearance to bone valves decompression technique in hematoma volume,skull,pressure high blood pressure brain hemorrhage treatment,and to further explore hypertension brain hemorrhage of reasonable surgery. Methods Hematoma in relatively large quantities of high intracranial pressure in hypertensive cerebral hemorrhage patients were randomly divided into experimental group and control group,and patients in the experimental group were implemented early hematoma puncture to attract a joint hematoma decompressive craniectomy treatment,and the control group were implemented the traditional hematoma de-compressive craniectomy treatment. The prognosis of the two groups were compared. Results The two groups were followed up for 6 months,and evaluated by ADL grade,between the two groups was statistically significant difference in ADL classification( P<0.01). Conclusion In the hematoma volume larger, high intracranial pressure in hypertensive cerebral hemorrhage in the surgical treatment of patients,the early line to attract a joint hematoma puncture decompressive craniectomy was a reasonable and feasible surgical method which can improve these patients prognosis. Key words: Intracranial hemorrhage, hypertensive ; Paracenteais; Craniotomy

Fibrinolytic therapy versus craniotomy for anticoagulant-associated intracerebral hemorrhage

Object Anticoagulant-associated intracerebral hemorrhages (AAICH) have a high morbidity and mortality, necessitating urgent treatment. We examined outcomes after conventional craniotomy and stereotactic fibrinolytic therapy in a series of patients with anticoagulant-associated hemorrhages. Methods Among 129 consecutive surgically treated patients with supratentorial intracerebral hemorrhage, 27 patients with AAICH were identified (mean age 62; range 36–79). Thirteen patients underwent craniotomy for surgical hematoma evacuation, and 14 patients hematoma puncture and catheter placement for clot lysis. The groups had comparable major prognostic factors such as hematoma volume, age, and Glasgow coma scale (GCS) score at admission. Results Nine patients died despite treatment (mortality = 33%). Mortality in the craniotomy group was comparable to that of the lysis group (46% versus 21%; p = 0.13). Good outcomes (Glasgow outcome score of 4 or 5) were seen in 3 craniotomy patients (23%) and 2 fibrinolysis patients (14%). Half the patients survived with major neurological deficits (GOS 2 or 3) ( n = 13; 48%). One rebleed was observed two days after uneventful craniotomy and hematoma removal, while no patient who underwent fibrinolysis had rebleeding. Conclusions Approximately one-fifth of patients with AAICH managed surgically may have good outcomes. Mortality and favourable outcome rates are comparable between craniotomy and fibrinolytic therapy. Fibrinolytic therapy appears to be a reasonable less invasive alternative treatment modality for intracerebral hemorrhage in the anticoagulated patient.

The rapeutic efficacies of different surgical methods for hypertensive intracerebral hemorrhage: a retrospective analysts

Objective To explore the the rapeutic efficacies of different surgical methods for hypertensive intracerebral hemorrhage so as to find out their indications. Methods Admittedin to 218 eases of hypertensive intracerebral hemorrhage since, which treated by tereotaetie aspiration or eraniotomy through small bone window or eraniotomy through bone flap was divided into three subgroups according to GCS scores and hematoma volume indications and trerapeutic outcomes of these three surgical methods were analyzed comparatively. Results Satisfactory prognosis was found in 64(60.4%) patients of brain hematoma puncture drainage. Satisfactory prognosis was found in 35(54.7%) patients of small windowing skull. No significant was occurred between the two groups (P＞0.05). The mortality rate decreased obviously in the bone-flap eraniotomy group with greathematoma volume (29.2%). Conclusions Puncture drainagc has small wound and instauration quickly. And valid for time to relief encephalothlipsis. In most circumstances, puncture drainage can replace the small hole craniotomy. Bone flap craniotomy can lower a great deal of apoplexy death rate. Key words: Intraeerebral hemorrhage, hypertensive; Craniotomy

Comparison of Frame-Based and Frameless Stereotactic Hematoma Puncture and Subsequent Fibrinolytic Therapy for the Treatment of Supratentorial Deep Seated Spontaneous Intracerebral Hemorrhage

This study compared the technical implications and clinical outcome of patients treated for an intracerebral hemorrhage using two minimally invasive procedures: frame-based stereotactic hematoma aspiration and frameless navigation-guided hematoma aspiration followed by fibrinolysis. Thirty patients with a spontaneous supratentorial intracerebral hemorrhage, which was treated by a frame-based (n=15) and frameless (n=15) hematoma aspiration followed by subsequent fibrinolysis with urokinase, were retrospectively reviewed. The data for the two subsets of patients were analyzed with regard to hematoma reduction, Glasgow Coma Scale (GCS), and degree of weakness. In the frame-based stereotactic hematoma aspiration group, the volume of the hematoma was 15.4-100.0 mL (mean: 40.7+/-24.4), the GCS upon admission was 4-15 (mean: 10.1+/-3.0), and the grade of weakness upon admission was 1-5 (mean: 2.1+/-0.9). On the other hand, in the frameless navigation-guided hematoma aspiration group, the hematoma volume was 15.2-62.0 mL (mean: 30.0+/-15.2), the GCS upon admission was 7-15 (mean: 13.0+/-2.4), and the grade of weakness upon admission was 1-4 (mean: 2.3+/-1.2). The drainage catheter was in place for a mean duration of 5.1+/-2.4 days (range: 1-12 days). In the frame-based group, the initial hematoma was reduced by -115-88.5% (mean: 52+/-31.5) immediately after surgery, and 90.5% (41-100%) of the initial volume 14 days after surgery. In the frameless group, the initial hematoma was reduced by 11.7-90.8% (mean 57.3+/-25.1) immediately after surgery and 95.8% (87.7-100%) 14 days after surgery. The GCS score and the degree of weakness were evaluated 14 days after surgery, and the Glasgow outcome scale (GOS) score was evaluated at discharge. There were no statistically significant differences between the two groups. The frame-based group and the frameless group followed by fibrinolysis had similar outcomes, and both procedures effectively reduced the intracerebral hemorrhage volume within a short period of time. In addition, these procedures are simple, precise, safe, and brief with a very low rebleeding rate and mortality.

Frame-based and frameless stereotactic hematoma puncture and subsequent fibrinolytic therapy for the treatment of spontaneous intracerebral hemorrhage

Comparison of two minimally invasive procedures for the treatment of intracerebral hemorrhage and subsequent lysis with regard to technical implications and clinical outcome of the patients. Retrospective analysis of 126 patients with spontaneous supratentorial intracerebral hemorrhage treated by frame-based (n=53) or frameless (n=75) hematoma aspiration and subsequent fibrinolysis with recombinant tissue plasminogen activator (rt-PA). Data were analysed for the whole group as well as for the two subsets of patients with regard to hematoma reduction, procedure-related complications, and the early and long term clinical outcome of the patients. Functional outcome was rated using the Glasgow Outcome Scale (GOS) and Barthel-Index (median follow-up 178 weeks). The prognostic impact of patient related covariates on the GOS was analysed using logistic regression analysis. 49 out of 126 patients (38.9 %) died, 25 of them in the early postoperative period. Only 22/126 (17.5 %) had a favorable long term outcome (GOS >3). Age > 65 years was significantly (p<0.03, OR 3.6) associated with a higher risk for an unfavorable long term outcome (GOS < or = 3). Treatment had no impact on outcome. Both techniques were highly effective in reducing the intracerebral blood volume by 75.8+/-21.4% of the initial hematoma volume in frame-based and 64.8+/-25.4 % in frameless stereotaxy within 2 days of rt-PA-therapy. Malpositioning of the catheter occurred more often in the frameless group (21.3% vs. 9.4 % in the frame-based procedure) without gaining statistical significance. Frame-based and frameless stereotactic hematoma aspirations with subsequent fibrinolysis are effective in volume reduction of intracerebral hemorrhage with comparable clinical outcome. The frameless procedure is associated with a higher risk for malpositioning of the catheter. Despite effective hematoma reduction with both techniques, the percentage of patients with a good clinical outcome remained limited especially in the elder subpopulation.