The Effect of Intracisternal Urokinase for the Development of Hydrocephalus after Experimental Subarachnoid Hemorrhage.

Kim, Hun Dae; Park, Youn Kwan; Chong, Yong Gu; Chung, Heung Seob; Suh, Jung Keun; Lee, Hoon Gap; Lee, Ki Chan; Chu, Jeong Wha

Original Article

Journal of Korean Neurosurgical Society 1990;19(8-9): 1198-1209.

Hun Dae Kim, Youn Kwan Park, Yong Gu Chong, Heung Seob Chung, Jung Keun Suh, Hoon Gap Lee, Ki Chan Lee, Jeong Wha Chu

Department of Neurosurgery, College of Medicine, Korea University, Seoul, Korea.

ABSTRACT

The authors has investigated the effect of intracisternal urokinase on the multihemorrhage canine model of chronic post-subarachnoid hemorrhage(SAH) hydrocephalus. Each of 16 adult mongrel dogs was assigned to one of two experimental groups. All animals received a total of 13ml of fresh unheparinized autologous blood via three cisternal injections. Eight animals were treated by intracisternal injection of 20,000 IU of Urokinase every 12 hours for 3 days, and the remaining were not treated. The changes in ventricular volumes were measured by computed tomography(CT) before and 3 months after the initial subarachnoid blood injection. To compare the changes of hydrodynamic properties in chronic phases of post-SAH hydrocephalus, the pressure-volume index(PVI) technique of bolus manipulation of cerebrospinal fluid(CSF) was used to measure the volume-buffering capacity of neural axis and the resistance to the absorption of CSF(before SAH, post-SAH 1 month, 3 months). The final ventricular volume at 3 months of control group was 4 times greater than the initial volume, but Urokinase group less than two times. The mean measured PVI values of control group and Urokinase group were 3.98+/-0.76ml(+/- standard deviation(SD)) and 4.01+/-0.82ml in baseline study, 3.09+/-0.96ml and 3.70+/-0.84ml in post-SAH 3 months. The mean resistance of CSF outflow of control group and Urokinase group were 10.30+/-2.24mm Hg/ml/min), and 10.34+/-1.98mm Hg/ml/min in baseline study. At 1 month and 3 months after SAH control group maintained high absorptive resistance(29.54+/-11.50mm Hg/ml/min, 22.43+/-3.82mm Hg/ml/min), whereas the resistances of Urokinase group were slightly increased and then returned to the original levels(16.04+/-4.87mm Hg/ml/min, 12.87+/-3.06mm Hg/ml/min). The results described in this experimental study indicated that if fibrinolysis of the subarachnoid blood clot can be achieved rapidly after SAH, the complicating chronic hydrocephalus might be prevented.

Key Words: Subarachnoid hemorrhage; Hydrocephalus; Urokinasa CT scan; CSF dynamic study