The experience of intrathecal fibrinolysis in surgery of massive intraventricular hemorrhage
DOI:
https://doi.org/10.25305/unj.51523Keywords:
hemorrhagic stroke, intraventricular hemorrhage, occlusive hydrocephalus, intrathecal fibrinolysisAbstract
Introduction. Intraventricular hemorrhage (IVH) was detected in 30% patients with hypertensive intracerebral hemorrhages, that significantly worsens disease prognosis and course. Lethality is particularly high at massive IVH.
Methods. 29 patients with massive IVH were operated (severity of the patient’s condition according to Graeb scale 7–10 scores), level of consciousness at the time of operation according to Glasgow Coma Scale (GCS) 8 scores and lower. All patients were operated on the 1st–2nd day of the disease, on the 1st day after hospitalization. For intrathecal fibrinolysis Actylise in doze 3,5 mg was used, it was introduced into each intraventricular catheter, exposure 3 hours. The procedure was repeated 4 times during 24 hours (every 6 hours).
Results. 17 (58,6%) patients were discharged from the clinic. 5 patients’ condition scored 4 on Glasgow Outcome Scale, 7 scored 3, five scored 2. Fibrinolytics are effective even in patients with complete tamponade of brain ventricular system, but patient’s initial GCS score has to be no lower than 6.
Conclusions. Intrathecal fibrinolysis is a promising method for massive IVH treatment. It is ineffective in patients, been hospitalized in critical condition, with GCS score lower than 6, and Graeb score 9–10.
References
1. Simanov YuV, Kolosov AS. Gipertenzivnyye vnutrimozgovyye krovoizliyaniya, CH. 1: etiologiya, patogenez, patomorfologiya [Hypertensive intracerebral hemorrhage, Part 1: etiology, pathogenesis, patomorfologija]. Nejrokhirurgia. 2001;3:1-21. Russian.
2. Skvortsova VI, Krylov VV., editors. Gemorragicheskiy insul't: prakt. Rukovodstvo [Hemorrhagic stroke: Practical Guidelines]. Moscow : GEOTAR-media; 2005. Russian.
3. Krylov VV, Dash'ian VG, Parfenov AL, Efremenko SV, Piradov MA, Ivanova NE, Pirskaia TN, Dobzhanskij NV, Shirshov AV, Skvortsova VI, Maksakova OA, Lapatukhin VG. [Recommendatory hypertensive intracerebral hematoma management protocol]. Zh Vopr Neirokhir Im NN Burdenko. 2007; Apr-Jun (2):3-9. Russian. [PubMed]
4. Zuccarello M, Brott T, Derex L, Kothari R, Sauerbeck L, Tew J, Van Loveren H, Yen HS, Tomsick T, Pancioli A, Khouri J, Broderick J. Early surgical treatment for supratentorial intracerebral hemorrhage: a randomized feasibility study. Stroke. 1999;30(9):1833-9. [PubMed] [CrossRef]
5. Jaffe J, Melnychuk E, Muschelli J, Ziai W, Morgan T, Hanley DF, Awad IA. Ventricular catheter location and the clearance of intraventricular hemorrhage. Neurosurgery. 2012;70(5):1258-64. [PubMed] [CrossRef]
6. Dey M, Jaffe J, Stadnik A, Awad IA. External ventricular drainage for intraventricular hemorrhage. Cur Neurol Neurosci Rep. 2012;12(1):24-33. [PubMed] [CrossRef]
7. Niizuma H, Shimizu Y, Yonemitsu T, Nacasato N, Suzuki J. Results of stereotactic aspiration in 175 cases of putaminal hemorrhage. Neurosurgery. 1989;24(6):814-9. [PubMed] [CrossRef]
8. Teernstra OP, Evers SM, Lodder J, Leffers P, Franke CL, Blaauw G. Stereotactic treatment of intracerebral hematoma by means of a plasminogen activator: a multicenter randomized controlled trial (SICHPA). Stroke. 2003;34:968-74. [PubMed] [CrossRef]
9. Rohde V, Schaller C, Hassler WE. Intraventricular recombinant tissue plasminogen activator for lysis of intraventricular hemorrhage. J Neurol Neurosurg Psychiat. 1995;58(4):447-51. [PubMed] [CrossRef]
10. Naff, N, Williams M, Keyl PM, Tuhrim S, Bullock MR, Mayer SA, Coplin W, Narayan R, Haines S, Cruz-Flores S, Zuccarello M, Brock D, Awad I, Ziai WC, Marmarou A, Rhoney D, McBee N, Lane K, Hanley DF Jr. Low-dose rt-PA enhances clot resolution in brain hemorrhage: The Intraventricular Hemorrhage Thrombolysis Trial. Stroke. 2011;42(11):3009-16. [PubMed] [CrossRef]
11. Staykov D, Bardutzky J, Huttner HB, Schwab S. Intraventricular fibrinolysis for intracerebral hemorrhage with severe ventricular involvement. Neurocrit Care. 2011;15(1):194-209. [PubMed] [CrossRef]
12. Krylov VV, Burov SA, Galankina I.E., Dash'yan VG. Punktsionnaya aspiratsiya i lokal'nyy fibrinoliz v khirurgii vnutricherepnykh krovoizliyaniy [Puncture aspiration and local fibrinolysis in the surgery of intracranial hemorrhage]. Moscow : Avtorskaya akademiya; Tovarishchestvo nauchnykh izdaniy KMK; 2009. Russian.
13. Saribekian AS. Khirurgicheskoye lecheniye gemorragicheskogo insul'ta metodom punktsionnoy aspiratsii i lokal'nogo fibrinoliza [Surgical treatment of hemorrhagic stroke by needle aspiration and local fibrinolysis]. Moscow : izdatel'skiy tsentr “Letopis’”; 2009.
14. Schaller C, Rohde V, Meyer B, Hassler W. Stereotactic puncture and lysis of spontaneous intracerebral hemorrhage using recombinant tissue-plasminogen activator. Neurosurgery. 1995;36(2):328-35. [PubMed] [CrossRef]
15. Schwarz S, Schwab S, Steiner HH, Hacke W. Secondary hemorrhage after intraventricular fibrinolysis:a cautionary note: a report of two cases. Neurosurgery. 1998;42(3):659-62. [PubMed] [CrossRef]
16. Vespa P, McArthur D, Miller C, O’Phelan K, Frazee J, Kidwell C, Saver J, Starkman S, Martin N. Frameless stereotactic aspiration with reduction of hemorrhage volume and neurological improvement. Neurocrit Care. 2005;2(3):274-81. [PubMed] [CrossRef]
17. Hinson HE, Melnychuk E, Muschelli J, Hanley DF, Awad IA, Ziai Drainage WC. efficiency with dual versus single catheters in severe intraventricular hemorrhage. Neurocrit Care. 2012;16(3):399-405. [PubMed] [CrossRef]
18. Krylov VV, Burov SA, Dash’ian VG, Smirnov DS. Intratekal'nyy fibrinoliz pri massivnykh netravmaticheskikh vnutrizheludochkovykh krovoizliyaniyakh [Intrathecal fibrinolysis at massive non-traumatic intraventricular hemorrhage]. Nejrokhirurgia. 2008;3:47. Russian.
19. Berezyuk MV, Tsimeyko OA, Moroz VV. [Сase from practice Observation of successful treatment of the patient with intraventricular hemorrhage]. Ukrainian Neurosurgical Journal. 2008;2:65-6. Russian. [eLIBRARY.ru]
20. Lippitz BE, Mayfrank L, Spetzger U, Warnke JP, Bertalanffy H, Gilsbach JM. Lisis of basal ganglia hemorrhage with recombinant tissue plasminogen activator (rtPA) after stereotactic aspiration: Initial resalt. Acta Neurochir. 1994;127(3-4):157-60. [PubMed] [CrossRef]
21. Tsymbalyuk VI, Nakhaba OO, Hrydina NYa. Vidstrochena kranioplastyka pislya velykoloskutnoyi kraniotomiyi (modyfikatsiyi #5 ta 6) [Deferred cranioplasty with lage patches after craniotomy (modifications #5 and #6)]. Nauk. visn. NMU im.O.O. Bohomol’tsya. 2011;2:28-31. Ukrainian.
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