Artikel
Catheter placement for lysis of spontaneous intracerebral hematomas: Is the navigated stylet better than pointer-guided frameless stereotaxy for intrahematomal catheter positioning?
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Autoren
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V. Malinova
- Klinik und Poliklinik für Neurochirurgie, Georg-August-Universität Göttingen, Deutschland
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F. Stockhammer
- Klinik und Poliklinik für Neurochirurgie, Georg-August-Universität Göttingen, Deutschland
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V. Rohde
- Klinik und Poliklinik für Neurochirurgie, Georg-August-Universität Göttingen, Deutschland
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Despite the STICH study, the optimal management of spontaneous intracerebral hemorrhages (ICH), especially if deep-seated, remains a matter of discussion. Lysis of the clot applying rtPA by an intrahematomal catheter is a minimally invasive and possibly effective treatment option, currently under investigation in a randomized trial. The position of the catheter in the core of the clot seems to be crucial for optimal clot lysis. To achieve this, framebased stereotaxy and frameless stereotaxy with guidance of an articulated arm were used. Recently, a pre-calibrated stylet for direct navigation was introduced for shunt surgery. In this study we evaluated the relative error (RE) describing the deviation of the catheter from the ideal core position in the clot and – compared the accuracy of the catheter positioning using frameless stereotaxy or the novel navigated stylet.
Methods: The catheter positioning in the ICH of 41 patients was evaluated in 3 dimensions. Frameless stereotaxy was performed in 30 patients. The navigated stylet was used in 11 patients. The catheter position was rated semiquantitatively (from 1: optimal position; to 5 position outside of the clot) and a RE calculating the distance perpendicular to the center of the catheter in relation to the hematomas diameter was defined.
Results: The median hemorrhage volume was 48 ml (range 10–113 ml). 23 hemorrhages were deep-seated. Satisfactory catheter position could be achieved in 83% using frameless stereotaxy and 100% using the stylet. The semiquantitative grading correlated with the RE (p = 0.0003; Spearman). The median RE in the stylet cases was less than in the stereotactic cases (0.50 vs. 0.81, p = 0.0316, t-test)
Conclusions: The RE is a robust measurement for describing catheter placement. The stylet facilitates a satisfactory catheter placement and should be used instead of frameless stereotaxy and guidance with an articulated arm or framebased stereotaxy. In a future trial, the question whether fibrinolysis via an optimally placed catheter is indeed more effective has to be addressed.
