Computed Tomography Controlled Aspiration Surgery for Hypertensive Intracerebral Hemorrhage

Abstract

To overcome the disadvantages of conventional surgery, we developed our own method of computed tomography controlled stereotactic aspiration surgery for hypertensive intracerebral hemorrhage. A new ultrasonic surgical aspirator was also developed to facilitate aspiration of a dense clot in the acute stage. Between 1980 and 1988, 437 patients with hypertensive intracerebral hemorrhage underwent aspiration surgery. Computed tomography controlled stereotactic aspiration surgery can be performed in hematomas of any site or any stage with minimal tissue damage, even in aged patients. Aspiration surgery led to a favorable clinical experience and outcome, especially in the acute stage.

Stereotactic Multiplanar Reformatted Computed Tomography-Guided Catheter Placement and Thrombolysis of Spontaneous Intracerebral Hematomas

“…Hondo described the use of a silicone catheter that was inserted into the center of the hematoma after three-dimensional CT images or biplane CT images were taken to determine the coordinates of the target point 8) . Unfortunately, detailed information on how often the adequate selection of the target point allowed optimal catheter positioning was not provided in the already published series on the use of the stereotactic CT-guided method for sICH.…”

“…Surgical treatment of ICH using various stereotactic techniques, including fibrinolytic instillation, has evolved over the years, but many investigators have reported aspiration rates ranging from 30% to 80% on average over the first few days 2,8) . Compared with data from the literature, the results obtained using this MPR CT-guided method were highly satisfactory for clot removal.…”

Critical Care Management and Monitoring of Intracranial Pressure

“…With cerebellar haemorrhage, although there are again no randomized controlled trials comparing surgical and conservative treatment, there seems to be greater agreement that haematomas greater than 3-4 cm should be operated upon, especially when there is concomitant clinical deterioration or hydrocephalus 36 -37 . Surgical options consist of: (i) conventional craniotomy and evacuation of the clot under direct vision, with or without the microscope; (ii) stereotactic aspiration through a burr hole -aspiration of a dense clot can be facilitated either by instillation of fibrinolytic agents or by fragmenting it by means of an ultrasonic device 38 ; and (iii) endoscopic surgery 39 . There is as yet no evidence to suggest the superiority of one Stroke method over another in terms of patient outcome.…”

Comparison of Spontaneous Intracerebral Hemorrhage Treatment in Germany Between 1999 and 2009

“…Moreover, approximately one fourth of the patients in the initially conservatively treated group subsequently underwent surgery. 18 Furthermore, stereotactic aspiration and fibrinolysis in the treatment of deep-seated intracerebral hemorrhage achieved satisfactory morphological results 19 but could not improve the patient's outcome significantly. [20][21][22] With regard to these findings, the results of our survey are interesting.…”