Free-Hand Bedside Catheter Evacuation of Cerebellar Hemorrhage

Abstract

Object: Cerebellar hemorrhage is a life-threatening condition that requires immediate surgical intervention. Open craniectomy, hemorrhage evacuation and posterior fossa decompression is the treatment of choice. Patients with aspirin antithrombotic medication, however, face an increased risk of postoperative rebleeding, because it is impossible to normalize blood coagulation in time. To sufficiently treat these patients, we have developed a minimally-invasive, free-hand, bedside catheter evacuation technique.

Clinical Presentation: In a retrospective analysis, two patients with a mean age of 68 years and antithrombotic aspirin medication with cerebellar hemorrhage were treated. On admission, mean hemorrhage volume was 30.25 mL or 3.7×4.75×3.03 cm, mean GCS was 7.5, initial aspiration drained a mean 24 mL of blood. After a mean of 2.5 days of urokinase lysis, mean hemorrhage volume was 3.7 mL or 2.25×2.0×1.15 cm and mean EGOS on discharge was 4.5. After a mean follow-up of 408 days, the mean EGOS was 5.5, and both patients were alive.

Conclusion: We conclude from these data that, in selected cases, bedside catheter placement and consequent urokinase lysis is a successful way to drain posterior fossa hemorrhage. However, experience in catheter positioning is crucial and the technique therefore should only be performed by experienced neurosurgeons.

hematoma - cerebellar hemorrhage - urokinase lysis - catheter

References

• 1 Rey-Bellet J. Cerebellar hemorrhage a clinico-pathologic study.  Neurology. 1960;  10 217-222
• 2 Hayward RD, O’Reilly GVA. Intracerebral haemorrhage.  Lancet. 1976;  3 1-4
• 3 Kase CS, Williams JP, Wyatt DA. et al . Lobar intracerebral hematomas: Clinical and CT analysis of 22 cases.  Neurology. 1982;  32 1146-1150
• 4 Margolis G, Odom GL, Woodhal B. et al . The role of small angiomatous malformations in the production of intracerebral hematomas.  J Neurosurg. 1951;  8 564-575
• 5 Mayer U, Bauer P, Fisher J. Non-traumatic intracerebral hemorrhage. Prognostic implications of neurological and computer-tomographical findings in 100 consecutive patients.  Neurochirurgia. 1983;  26 36-41
• 6 Ropper AH, Davis KR. Lobar cerebral hemorrhage: Acute clinical syndromes in 26 cases.  Ann Neurol. 1980;  8 141-147
• 7 Takasugi S, Sogo T, Matuda T. et al . Management of hypertensive intracerebral hemorrhage-based on the natural course of the hematoma observed by repeated CT scan.  Neurol Med Chir. 1979;  19 261-269
• 8 Teernstra OPM, Evers SMAA, Lodder J. et al . Stereotactic treatment of intracerebral hematoma by means of a plasminogen activator. A multicenter randomized controlled trial (STICHPA).  Stroke. 2003;  34 968-974
• 9 Auer L, Auer T, Sayama I. Indications for surgical treatment of cerebellar haemorrhage and infarction.  Acta Neurochir. 1985;  79 74-79
• 10 Da Pian R, Bazzan A, Pasqualin A. Surgical versus medical treatment of spontaneous posterior fossa hematomas: A cooperative study on 205 cases.  Neurol Res. 1984;  6 145-151
• 11 Heros RS. Surgical treatment of cerebellar infarction.  Stroke. 1992;  23 937-938
• 12 Broderick J, Adams Jr HP, Barsan W. et al . Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association.  Stroke. 1999;  30 909-915
• 13 Yanaka K, Meguro K, Fujita K. et al . Immediate surgery reduces mortality in deeply comatose patients with spontaneous cerebellar hemorrhage.  Neurol Med Chir. 2000;  40 295-300
• 14 Lippitz BE, Mayfrank L, Spetzger U. et al . Lysis of basal ganglia haematoma with recombinant tissue plasminogen activator (rt-PA) after stereotactic aspiration: initial results.  Acta Neurochir. 1994;  127 157-160
• 15 Rohde V, Rohde I, Reinges MHT. et al . Frameless stereotactically guided catheter placement and fibrinolytic therapy for spontaneous intracerebral hematomas: technical aspects and initial clinical results.  Minim Invas Neurosurg. 2000;  43 9-17
• 16 Mohadjer M, Braus DF, Myers A. et al . CT-stereotactic fibrinolysis of spontaneous intracerebral hematomas.  Neurosurg Rev. 1992;  15 105-110
• 17 Schaller C, Rohde V, Meyer B. et al . Stereotactic puncture and lysis of spontaneous intracerebral hemorrhage using recombinant tissue-plasminogen activator.  Neurosurgery. 1995;  36 328-335
• 18 Tyler D, Mandybur G. Interventional MRI-guided stereotactic aspiration of acute/subacute intracerebral hematomas.  Stereotact Funct Neurosurg. 1999;  72 129-135
• 19 Doi E, Moriwaki H, Komai N. et al . Stereotactic evacuation of intracerebral hematomas.  Neurol Med Chir. 1982;  22 461-467
• 20 Matsumoto K, Hondo H. CT-guided stereotaxic evacuation of hypertensive intracerebral hematomas.  J Neurosurg. 1984;  61 440-448
• 21 Niizuma H, Otsuki T, Johkura H. et al . CT-guided aspiration of intracerebral hematoma - Result of a hematoma-lysis method using urokinase.  Appl Neurophysiol. 1985;  48 427-430
• 22 Pollak L, Rabey JM, Gur R. et al . Indication to surgical management of cerebellar hemorrhage.  Clin Neurol Neurosurg. 1998;  100 99-103
• 23 Yamamoto T, Nakao Y, Mori K. et al . Endoscopic hematoma evacuation for hypertensive cerebellar hemorrhage.  Minim Invasive Neurosurg. 2006;  49 173-178

Correspondence