Video Consultation: A New Way to Improve Inter‐hospital Neurosurgical Patient Care

Abstract

We review our experience with patients harbouring putaminal intracerebral haematoma treated by intraoperative ultrasound guided aspiration and thrombolysis with Urokinase. We assessed the feasibility and safety of the procedure and compared the results with a similar group of patients previously treated in our unit by craniotomy and clot evacuation. From September 1998 to May 2000, eighteen consecutive patients with putaminal haemorrhage without suspected underlying structural aetiology or coagulopathy were included. Under general anesthesia, a catheter was inserted into the centre of the haematoma through a frontal burr hole under ultrasound guidance. An external ventricular catheter was also inserted for intracranial pressure monitoring. After maximally aspirating the haematoma, the catheter was left in place and 30 000 units of urokinase instilled. Further instillation of 20 000 units of urokinase was performed every 12 hours. The resolution of haematoma was followed with serial CT scan. The mean age was 55 years; mean haematoma size was 50 mL. The mortality rate was 11% (2/18); both deaths were not procedure related. Twenty-four patients were in the craniotomy; there were three deaths (13%). Other outcomes of the two groups were similar. We concluded that ultrasound guided aspiration and thrombolysis appears safe and effective in treating putaminal haemorrhage.Various methods and material have been used to treat cranium bifidum. We report the use of split calvarium bone graft in the treatment of the condition in a 3-year-old girl with a large bilateral parietooccipital defect. Early follow up reveals satisfactory results. 4.