J Cerebrovasc Endovasc Neurosurg.  2015 Mar;17(1):7-12. 10.7461/jcen.2015.17.1.7.

CT Fluoroscopy-guided Aspiration of Intracerebral Hematomas: Technique and Outcomes

• Hwang K
• Hwang G
• Kwon OK
• Bang JS
• Oh CW

• KMID: 1963143
• DOI: http://doi.org/10.7461/jcen.2015.17.1.7

Abstract

OBJECTIVE
The authors evaluated the feasibility and targeting accuracy of CT fluoroscopy (CTF)-guided catheter placement and aspiration of intracerebral hematoma (ICH)s.
MATERIALS AND METHODS
Nine patients (mean age, 63.3 +/- 15.3 years) were treated by CTF-guided hematoma aspiration under local anesthesia. The targeting errors in the lesion center, volume of the aspirated hematoma, accuracy of the final catheter position, procedure time, and clinical outcomes were evaluated.
RESULTS
All catheters were successfully placed in the center of the hematoma. The mean volume of the aspirated hematoma was 20.6 +/- 8.8 mL (pre-treatment, 44.7 +/- 20.1 mL; post-treatment, 24.1 +/- 13.8 mL). The average procedure time was 25.1 minutes (range, 18-32 minutes). In one case with a scanty residual hematoma, the catheter was removed at the end of the procedure. In the remaining eight cases, the catheter was left in the residual hematoma for drainage and all catheter tips were accurately located in the final position. There were no procedure-related complications, including rebleeding and infection.
CONCLUSION
CTF-guided ICH aspiration is a feasible, quick, and accurate procedure which could substitute for stereotactic methods. The accurate catheter position provided by real-time observation enables an effective aspiration and drainage of hematomas.

Keyword

Intracerebral hemorrhage; CT fluoroscopy; Stereotactic surgery

MeSH Terms

Anesthesia, Local
Catheters
Cerebral Hemorrhage
Drainage
Fluoroscopy
Hematoma*
Humans

Figure

• 

  Fig. 1 Case 5. A large amount of hematoma is observed in the right putamen on pre-treatment computed tomography (CT) (55.5 mL, A). Using CT fluoroscopy, a 12-Fr silicon catheter can be placed in the center of hematoma (B). After the procedure, post-treatment CT scan (C) shows the small amount of residual hematoma (23.5 mL), which was successfully drained with a single urokinase (4,000 IU) injection via the catheter.

• 

  Fig. 2 Case 3. Using computed tomography (CT) fluoroscopy, a 12-Fr silicon catheter is advanced into the hematoma in the right frontal lobe (34.1 mL, A and B). Post-treatment CT scan (C) shows relief of the mass effect of the hematoma. Urokinase was not necessary for the residual hematoma (17.4 mL).

• 

  Fig. 3 Case 1. The initial computed tomography (CT) scan shows a right cerebellar hematoma extending to the 4th ventricle measuring 28.4 mL in volume (A). Under CT fluoroscopy guidance, a 12-Fr silicon tube is inserted through a small burr hole in the suboccipital area (B). After aspiration of the hematoma, a small amount of hematoma (6.2 mL) which did not require subsequent lysis with fibrinolytics is shown on post-treatment CT scan (C).

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