Frameless stereotactically guided catheter placement and fibrinolytic therapy for spontaneous intracerebral hematomas: Technical aspects and initial clinical results

Objective: Frame-based stereotactic puncture and catheter placement followe d by fibrinolytic therapy and drainage is one treatment option in the manag ement of spontaneous intracerebral hemorrhage (sICH). This minimally invasi ve procedure could even be simplified by frameless stereotaxy. The authors present their experiences with frameless stereotactic image-guided catheter placement for lysis and drainage of sICH, with emphasis on technical aspec ts. Method: In 27 patients with sICH, an infrared-based frameless stereotac tic device was used for selecting trajectory and target point of hematoma d rainage. A trajectory along the main axis of the hematoma was considered to be optimal for fibrinolytic therapy. An articulated arm served to maintain the predetermined trajectory during surgery and to guide catheter advancem ent. Clot lysis with recombinant tissue plasminogen activator (rt-PA) was i nitiated after radiological confirmation of correct catheter positioning. R esults: In all cases, selection of the optimal trajectory was not restricte d by the frameless stereotactic device. In 25 of the 27 patients, the cathe ter was placed accurately along the predetermined trajectory into the targe t point. In two patients, the catheter was positioned at the lateral margin of the hematoma, excluding fibrinolytic therapy in one case. In 24 of 27 p atients, the mean hematoma volume could be reduced from initially 52 ml to 17 ml in an average of two days. Hematoma enlargement following rt-PA injec tion was observed in two patients. Further complications were culture negat ive pleocytosis of cerebrospinal fluid in two and meningitis in one patient . Conclusion: Hematoma puncture and catheter placement for fibrinolytic the rapy could be achieved with high accuracy and safety using frameless stereo taxy. This method allows unrestricted trajectory selection with catheter po sitioning along the main hematoma axis. Further studies are required to inv estigate if frameless stereotactic puncture and clot lysis could contribute to improve the outcome of patients with sICH.