Stereotactic Management of Spontaneous Infratenorial Hemorrhage: Part I:Stereotactic Evacuation and Gradual Urokinase Irigation for Spontaneous Brain Stem Hemorrhage.

Cho, Soo Ho; Baek, Seung Chan; Ihm, Jowa Hyuk; Kim, Oh Lyong; Chi, Yong Chul; Choi, Byung Yearn

Original Article

Journal of Korean Neurosurgical Society 1988;17(3): 437-446.

Soo Ho Cho, Seung Chan Baek, Jowa Hyuk Ihm, Oh Lyong Kim, Yong Chul Chi, Byung Yearn Choi

Department of Neurosurgery, College of Medicine, Yeungnam University, Taegu, Korea.

ABSTRACT

In spontaneous brain stem hemorrhage, efforts are being made to treat the hemorrhage by means of active medical treatment of intricate suboccipital craniectomy. But these efforts are still unsatisfactory in decreasing the high mortality and morbidity. Our recent efforts have got good results in the 11 cases of brain stem hemorrhage by removing the hemorrhage through the application of R.R.W. stereotactic system and gradual urokinase irrigation. The residual hemorrhage following the initial aspiration was completely evacuated by gradual urokinase irrigation through stereotactically placed catheter. Also this catheter was used for monitoring of intrahematomal intracranial pressure for an early stoppage of the increased intracranial pressure or early detecting of rebleeding. This kind of stereotactic evacuation and gradual irrigation with urokinase could remove the brain stem hemorrhage accurately and easily in a short time under the local anesthesia. Mean-while the normal brain tissue is subjected to less surgical trauma by this procedure, which can be interpreted as having a wide indication, a definite advantage, with a low mortality of 27.3%.

Key Words: Brain stem hemorrhage; Stereotatic evacuation; Urokinase irrigation; Intrahematomal pressure monitoring; Impedance