Frameless stereotactic aspiration and subsequent fibrinolytic therapy for the treatment of spontaneous intracerebral haemorrhage

Background and purpose. The options for managing spontaneous intracerebral haemorrhage (ICH) include conservative treatment, surgical removal of the haematoma and minimally invasive treatment with clot aspiration and subsequent fibrinolytic therapy. The discussion over which treatment is best for ICH remains controversial and management of patients with spontaneous ICH continues to be a challenge. The purpose of this study is to investigate the feasibility and safety of frameless stereotactic aspiration and subsequent fibrinolytic therapy for the treatment of spontaneous ICH. Methods. Patients with spontaneous supratentorial ICH were treated by a frameless stereotactic aspiration using the YL-1 type of intracranial haematoma puncture needle, followed by subsequent fibrinolytic therapy with urokinase. Results. Forty-eight patients were enrolled in the study. The median age was 65 years (range, 40-79). The median initial Glasgow Coma Scale (GCS) was 10 (range 6-14). The mean initial haematoma volume was 56.5 cm(3). Initial ICH volume was reduced by an average of 75% (range 50-90%). Ten patients (20.8%) died before hospital discharge. By the 3-month follow-up, another two patients had died, resulting in an overall mortality of 25.0%. For the primary end point, a good outcome (3-month GOS score >3) rate was noted in 41.7% of the patients. No intraoperative death was observed in this study. There were a total of 14 (29.2%) procedure-related complications, with an overall re-bleeding rate of 10.4%. Conclusions. Frameless stereotactic aspiration using the YL-1 type of intracranial haematoma puncture needle and subsequent fibrinolytic therapy for the treatment of spontaneous ICH is a simple and safe procedure with low re-bleeding rate and mortality.