CT-guided stereotactic fibrinolysis of spontaneous and hypertensive cerebellar hemorrhage: long-term results

Abstract

The surgical indication for spontaneous cerebellar hemorrhage is not as controversial as the operative management of intracranial hemorrhage. Timing of the operation is crucial: intervening too early can produce an additional strain on the patient and an increased risk, while waiting too long to evacuate the hematoma can be fatal. This dilemma may be a factor in the relatively high mortality and morbidity rates following both operative and conservative treatment that have been reported in the literature (42.5% and 30%, respectively). In long-term studies on 14 patients, the authors have shown that stereotactic puncture and fibrinolysis for cerebellar hemorrhage is a valuable alternative to treatments used currently. The method consists of computerized tomography (CT)-guided stereotactic puncture and partial evacuation of the hematoma. After fibrinolysis with urokinase, the residual hematoma can be completely evacuated via a catheter introduced into the cavity of the hematoma. Only one of the 14 patients died in the direct postoperative phase; the remaining patients were enjoying a good to very good quality of life 6 months after the acute event. Two patients subsequently died as a result of pneumonia and cerebral infarction, respectively; both conditions were unrelated to the hemorrhage. The authors conclude that the CT-guided stereotactic method is simple, effective, and safe, and can be applied to patients of any age.

Prognostic factors in the treatment of cerebellar haemorrhage

“…It is interesting to note that Mohadjer (1990) and Nizen (1987) reported astonishing low mortality rates. But this can be attributed to the particular selection of their patients who have been stereotactically treated.…”

Frameless stereotactic aspiration and subsequent fibrinolytic therapy for the treatment of spontaneous intracerebral haemorrhage

“…Removal of the clot may also cause secondary tissue destruction and edema in the vicinity of the haematoma either by preventing compartmental pressure changes and the consecutive decrease in the blood flow perfusion pressure or by removing the clot caused by the toxic blood byproducts. 3,4 Therefore, minimally invasive surgery with subsequent fibrinolytic therapy was attempted and has been shown to be quite effective in treating larger haematomas. 5 Although less invasive stereotactic haematoma aspiration yielded good results, animal experiments indicate that early stereotactic intervention with additional local urokinase application is the most effective procedure for treating basal ganglia haematomas.…”

Vermal cerebellar hemorrhage as the initial manifestation of undiagnosed hypertension

“…2 Uncontrolled hypertension is the commonest etiology of spontaneous cerebellar hemorrhage. 3,4 There are a few reports on vermal cerebellar bleed in the literature. The cases described include those arising from a ruptured aneurysm of the posterior inferior cerebellar artery, haemophilia A, supratentorial surgery and anticoagulants.…”