Stereotactically guided thrombolysis of deep cerebral hemorrhage: preliminary results
David W. Miller, MD
Gene H. Barnett, MDAddress reprint requests to G.H.B., Department of Neurological Surgery, S80, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Donald W. Kormos, PhD
Charles P. Steiner, BS
The neurologic outcome from conventional medical or surgical therapy of intracerebral hemorrhage (ICH) is poor; however, stereotactically guided instillation of thrombolytic agents to dissolve parenchymal clots due to hypertensive hemorrhage has recently produced results 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 four patients with hypertensive ICH. After the hemorrhage was localized using angiography and computed tomography-assisted stereotactic technique, a ventricular catheter was used to administer urokinase to the clot.RESULTS
Preliminary results showed dramatic reduction in clot volume within 48 hours of initiating treatment and modest clinical improvement in all four patients. No further hemorrhages were seen after treatment. Three patients ultimately died of non-neurologic causes.CONCLUSIONS
With careful patient selection, stereotaxy-assisted thrombolytic therapy may be an advance in the treatment of certain cases of ICH.