Abstract
Objectives
Comparison of two minimally invasive procedures for the treatment of intracerebral hemorrhage and subsequent lysis with regard to technical implications and clinical outcome of the patients.
Methods
Retrospective analysis of 126 patients with spontaneous supratentorial intracerebral hemorrhage treated by frame-based (n=53) or frameless (n=75) hematoma aspiration and subsequent fibrinolysis with recombinant tissue plasminogen activator (rt-PA). Data were analysed for the whole group as well as for the two subsets of patients with regard to hematoma reduction, procedure-related complications, and the early and long term clinical outcome of the patients. Functional outcome was rated using the Glasgow Outcome Scale (GOS) and Barthel-Index (median follow-up 178 weeks). The prognostic impact of patient related covariates on the GOS was analysed using logistic regression analysis.
Results
49 out of 126 patients (38.9 %) died, 25 of them in the early postoperative period. Only 22/126 (17.5 %) had a favorable long term outcome (GOS >3). Age > 65 years was significantly (p<0.03, OR 3.6) associated with a higher risk for an unfavorable long term outcome (GOS ≤ 3). Treatment had no impact on outcome. Both techniques were highly effective in reducing the intracerebral blood volume by 75.8±21.4% of the initial hematoma volume in frame-based and 64.8±25.4 % in frameless stereotaxy within 2 days of rt-PA-therapy. Malpositioning of the catheter occurred more often in the frameless group (21.3% vs. 9.4 % in the frame-based procedure) without gaining statistical significance.
Conclusions
Frame-based and frameless stereotactic hematoma aspirations with subsequent fibrinolysis are effective in volume reduction of intracerebral hemorrhage with comparable clinical outcome. The frameless procedure is associated with a higher risk for malpositioning of the catheter. Despite effective hematoma reduction with both techniques, the percentage of patients with a good clinical outcome remained limited especially in the elder subpopulation.
Similar content being viewed by others
References
Auer LM, Deinsberger W, Neiderkorn K, Kleinert R, Schneider G, Holzer P, Bone G, Mokry M, Korner E, Kleinert G, Hanusch S (1989) Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg 70:530–535
Beatty RM, Zervas NT (1973) Stereotactic aspiration of a brainstem haematoma. Neurosurgery 13:204–207
Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G (1993) Volume of intracerebral hemorrhage: a powerful and easy-to-use predictor of 30-day mortality. Stroke 24:987–993
Brott T, Broderick J, Kothari R, Barsan W, Tomsick T, Sauerbeck L, Spilker J, Duldner J, Khoury J (1997) Early growth in patients with intracerebral hemorrhage. Stroke 28:1–5
Deinsberger W, Lang C, Hornig C, Boeker DK (2003) Stereotactic aspiration and fibrinolysis of spontaneous supratentorial intracerebral hematomas versus conservative treatment: A matched-pair study. Zentralbl Neurochir 64:145–150
Dorward NL, Paleologos TS, Alberti O, Thomas DGT (2002) The advantages of frameless stereotactic biopsy over frame-based biopsy. Br J Neurosurg 16:110–118
Fujii Y, Tanaka R, Takeuchi S, Koike T, Minakawa T, Sasaki O (1994) Hematoma enlargement in spontaneous intracerebral hemorrhage. J Neurosurg 80:51–57
Hankey GJ, Hon C (1997) Surgery for primary intracerebral hemorrhage: is it safe and effective? A systematic review of case series and randomized trials. Stroke 82:2126–2132
Juvela S, Heiskanen O, Poranen A, Valtonen S, Kuurne T, Kaste M, Troupp H (1989) The treatment of spontaneous intracerebral hemorrhage: a prospective randomized trial of surgical and conservative treatment. J Neurosurg 70:755–758
Kazui S, Naritomi H, Yanamoto H, Sawada T, Yamaguchi T (1986) Enlargement of spontaneous intracerebral hemorrhage: incidence and time course. Stroke 27:1783–1787
Lippitz BE, Mayfrank L, Spetzger U, Warnke JP, Bertalanffy H, Gilsbach JM (1994) Lysis of basal ganglia haematoma with recombinant tissue plasminogen activator (rt-PA) after stereotactic aspiration: initial results. Acta Neurochir (Wien) 127:157–160
McKissock W, Richardson A, Taylor J (1961) Primary intracerebral haemorrhage: a controlled trial of surgical and conservative treatment in 180 unselected cases. Lancet 2:221–226
Mendelow AD, Teasdale GM, Barer D, Fernandes HM, Murray GD, Gregson BA (2003) Outcome assignment in the International Surgical Trial of Intracerebral Haemorrhage. Acta Neurochir (Wien) 145:679–681
Mohadjer M, Braus DF, Myers A, Scheremet R, Krauss JK (1992) CTstereotactic fibrinolysis of spontaneous intracerebral hematomas. Neurosurg Rev 15:105–110
Montes JM, Womg JH, Fayad PB, Awad IA (2000) Stereotactic computed tomographic-guided aspiration and thrombolysis of intracerebral hematoma: protocol and preliminary experience. Stroke 31:834–840
Morgenstern LB, Frankowski RF, Shedden P, Pasteur W, Grotta JC (1998) Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial. Neurology 51:1359–1363
Niizuma H, Otsuki T, Johkura H, Nakazato N, Suzuki J (1985) CT-guided stereotactic aspiration of intracerebral hematoma: result of a hematoma-lysis method using urokinase. Appl Neurophysiol 48:427–430
Niizuma H, Shimizu Y, Yonemitsu T, Nakasato N, Suzuki J (1989) Results of stereotactic aspiration in 175 cases of putaminal haemorrhage. Neurosurgery 24:814–819
Prasad K, Browman G, Srivastava A, Menon G (1997) Surgery in primary supratentorial intracerebral hematoma: a meta-analysis of randomized trials. Acta Neurol Scand 95:103–110
Rohde V, Rohde I, Reinges MHT, Mayfrank L, Gilsbach JM (2000) Frameless Stereotactically Guided Catheter Placement and Fibrinolytic Therapy for Spontaneous Intracerebral Hematomas: Technical Aspects and Initial Clinical Results. Minim Invas Neurosurg 43:9–17
Rohde V, Rohde I, Thiex R, Ince A, Jung A, Dückers G, Gröschel K, Röttger C, Küker W, Müller HD, Gilsbach JM (2002) Fibrinolysis therapy achieved with tissue plasminogen activator and aspiration of the liquefied clot after experimental intracerebral hemorrhage: rapid reduction in hemaotma volume but intensification of delayed edema formation. J Neurosurg 97:954–962
Schaller C, Rohde V, Meyer B, Hassler W (1995) Stereotactic Puncture and Lysis of Spontaneous Intracerebral Hemorrhage Using Recombinant Tissue-Plasminogen Activator. Neurosurgery 36:328–335
Teernstra OPM; Evers SMAA, Lodder J, Leffers P, Franke CL, Blaauw G (2003) Stereotactic treatment of intracerebral hematoma by means of a plasminogen activator. A multicenter randomized controlled trial (STICHPA). Stroke 34:968–974
Thiex R, Küker W, Müller HD, Rohde I, Schröder JM, Gilsbach JM, Rohde V (2003) The long-term effect of recombinant tissue-plasminogen-activator (rt-PA) on edema formation in a largeanimal model of intracerebral hemorrhage. Neurol Res 25:254–262
Tyler D, Mandybur G (1999) Interventional MRI-guided stereotactic aspiration of acute/subacute intracerebral hematomas. Stereotact Funct Neurosurg 72:129–35
Zuccarello M, Brott T, Derex L (1999) Early surgical treatment for supratentorial intracerebral hemorrhage: a randomized feasibility study. Stroke 30:1833–1839
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Thiex, R., Rohde, V., Rohde, I. et al. Frame-based and frameless stereotactic hematoma puncture and subsequent fibrinolytic therapy for the treatment of spontaneous intracerebral hemorrhage. J Neurol 251, 1443–1450 (2004). https://doi.org/10.1007/s00415-004-0554-5
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00415-004-0554-5