Article
Intrahematomal catheter placement with connection to the ventricular system allows more effective lysis of combined intracerebral and intraventricular hematomas
Search Medline for
Authors
-
Bogdan Iliev
- Klinik für Neurochirurgie, Georg-August-Universität, Göttingen, Germany
-
Anna Schlegel
- Klinik für Neurochirurgie, Georg-August-Universität, Göttingen, Germany
-
Dorothee Mielke
- Klinik für Neurochirurgie, Georg-August-Universität, Göttingen, Germany
-
Veit Rohde
- Klinik für Neurochirurgie, Georg-August-Universität, Göttingen, Germany
-
Vesna Malinova
- Klinik für Neurochirurgie, Georg-August-Universität, Göttingen, Germany
| Published: | June 8, 2016 |
|---|
Outline
Text
Objective: Intracerebral hematomas (ICH) with rupture into the ventricle are associated with a high morbidity. Minimally invasive surgical techniques with intrahematomal or intraventricular rtPA application in patients with intraparenchymal or intraventricular hemorrhage allow a faster hematoma resolution compared to conservative treatment. The aim of this study was to evaluate whether the effectiveness of intraparenchymal and intraventricular clot lysis could be enhanced by intrahematomal catheter placement with connection to the ventricle.
Method: The volume of the intraparenchymal and intraventricular clot was measured. The relative volume reduction (RVR) of the intraventricular clot for every ventricle within 3 days and the RVR of the intraparenchymal clot within 4 days on average (range: 3-12 days) was calculated. The catheter was placed using frameless stereotaxy.
Results: We retrospectively analyzed 99 patients with spontaneous ICH. In 57% (56/99 patients) the hematoma was deep-seated. Accompanying intraventricular hemorrhage was seen in 81% (80/99 patients). In 48% (38/80 patients) an intrahematomal catheter with connection to the ventricle was placed. The RVR of the intraparenchymal clot (mean 57% vs. 43%) was significantly higher in the patients with a catheter connected to the ventricle than in patients with a catheter solely in the intraparenchymal clot (p=0.0001). We also found a significantly higher RVR of the intraventricular clot in the patients with a catheter connected to the ventricle (right ventricle: 15.5% vs. 2.2% p=0.02; left ventricle: 14.1% vs. 1.6% p=0.01; third ventricle: 45.6% vs. 28.1% p=0.0006; fourth ventricle: 51.5% vs. 28.1% p=0.0001).
Conclusions: According to the results of this study the intrahematomal catheter with connection to the ventricle allows simultaneous lysis of the intraparenchymal and intraventricular clot and a more effective clot volume reduction. We assume that the fibrinolytic property of the cerebrospinal fluid itself and a wash-out effect contribute to these findings. In patients with ICH extending to the ventricular system, in which minimally invasive fibrinolytic therapy is considered, catheter positioning through the hematoma into the ventricle should be attempted.
