STEREOTAXICALLY GUIDED THROMBOLYSIS OF DEEP CEREBRAL-HEMORRHAGE - PRELIMINARY-RESULTS

BACKGROUND The neurologic outcome from conventional medical or surgica l therapy of intracerebral hemorrhage (ICH) is poor; however, stereota ctically guided instillation of thrombolytic agents to dissolve parenc hymal clots due to hypertensive hemorrhage has recently produced resul ts equal to or better than those obtained with conventional therapies. OBJECTIVE To determine whether stereotactic thrombolysis of deep ICH is safe and effective. METHODS We administered urokinase to clots in f our patients with hypertensive ICH. After the hemorrhage was localized using angiography and computed tomography-assisted stereotactic techn ique, a ventricular catheter was used to administer urokinase to the c lot. RESULTS Preliminary results showed dramatic reduction in clot vol ume within 48 hours of initiating treatment and modest clinical improv ement in all four patients. No further hemorrhages were seen after tre atment. Three patients ultimately died of non-neurologic causes. CONCL USIONS With careful patient selection, stereotaxy-assisted thrombolyti c therapy may be an advance in the treatment of certain cases of ICH.