J Cerebrovasc Endovasc Neurosurg.  2022 Jun;24(2):121-128. 10.7461/jcen.2021.E2021.08.009.

A study on the proper catheter position in minimally invasive surgery using stereotactic aspiration plus urokinase for intracerebral hemorrhage

• Rho S
• Kim TS
• Joo SP
• Gong TS
• Kim HJ
• Park M

• KMID: 2531654
• DOI: http://doi.org/10.7461/jcen.2021.E2021.08.009

Abstract

Objective
The surgical method for treating spontaneous intracranial hemorrhage (ICH) is not well established despite ICH’s high prevalence and poor prognosis. Minimally invasive surgery has recently received attention; however, literature on this method is scarce. In particular, the appropriate location of the catheter in the hematoma has not been described. We examined whether the catheter position affects the hematoma reduction in a hematoma ＞50 cc.
Methods
We investigated the prognoses of 36 patients with ICH who underwent stereotactic aspiration and hematoma drainage using urokinase from January 2010 to December 2018 and the hematoma reduction rates according to the tube position. Two methods evaluated the position of the catheter. In the first method, the hematoma was an imaginary sphere. The center point was set as the operation target. We evaluated the catheter position by determining whether it was in the deep part or the outer part of the half point from that location to the hematoma margin. In the second method, we evaluated whether the catheter was located 1 cm inside the hematoma margin.
Results
In both the first and second evaluations, there were no differences in age, midline shift, intraventricular hemorrhage status, hematoma volume on admission, Glasgow Coma Scale score on admission, time to operation after symptom onset, and systolic blood pressure. The rates of decrease in bleeding and the prognoses were also not significantly different.
Conclusions
If the catheter is in the hematoma, the rate of hematoma reduction at any position is similar.

Keyword

Stereotactic techniques; Intracerebral hematoma; Minimally invasive surgical procedures

Figure

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  Fig. 1. Dividing into two zones along the long axis of the hematoma, each zone was assumed to be an imaginary sphere.

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  Fig. 2. Divide the radius of each circle in half and if the catheter is in the center, it is called a good position (A). When the catheter is halfway out, it is called a poor position (B).

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  Fig. 3. The good position (A) is the case that the tube is 1cm deeper from the margin of the hematoma, and the case where the tube is located outside is called the poor position (B).

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  Fig. 4. Hematoma volume in 1cm margin method groups by POD. POD, postoperative day.

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  Fig. 5. GCS in two circles half method groups by POD. GCS, Glasgow coma scale; POD, postoperative day.

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  Fig. 6. Hematoma volume in two circles half method groups by POD. POD, postoperative day.

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  Fig. 7. GCS in 1cm margin method groups by POD. POD, postoperative day

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