The Surgical Results of C-T Guided Stereotactic Early Aspiration with Urokinase Irrigation on Deep Seated Spontaneous Intracerebral Hemorrhage

Choi, Young Gun; Hamm, In Suk; Sung, Joo Kyung; Hwang, Seung Kyoo; Park, Yeun Mook; Kim, Seung Lae

Abstract

C-T guided stereotactic early burr hole aspirations performed on 106 spontaneous deep intracerebral hematoma patients in the Department of Neurosurgery, Kyungpook University Hospital, between January 1992 and December 1993. For average five days following the operation, continual urokinase(UK) irrigation was done for complete removal of the remaining hematoma. Of the patients, 73 who were operated on within three days of bleeding ictus were chosen for analyses and evaluation by factors believed to affect the final results. Eighty six percent was found to have hypertension as it's cause. The hematoma was removed completely in 13.7% of all the patients on post operation 1st day and 45% within 7 days by urokinase irrigation. The site of hematoma in thalamocapsulo-lenticular area showed a rather poor remission rate compared with those in other locations along with a higher mortality rate. By comparison between the time of admission and discharge, the state of consciousness of patients showed much improvement with 440% of the number of alert patients on discharge:motor function also showed significant improvement with 450% good patients number. In case of poor state of consciousness or motor function on admission, the mortality rate was higher. Rebleeding after aspiration was found in 6.8% and in all the cases except one the operation was done within 24 hours of bleeding, which resulted in poor postoperative outcome without improvement. Pneumonia was most common complication during admission followed by hydrocephalus. Mortality rate was 8.2%, most of which resulted from direct brain damage through bleeding. This surgical method is simple, safe and efficient in treating spontaneous deep intracerebral hematoma with no significant outcome difference when compared with early craniotomy.