Three-dimensional computed tomography-guided multitract aspiration of extensive ganglionic hemorrhage: technical note

Abstract

Background: We describe a methodology for effectively improving the lysis and drainage of intracerebral hematomas during stereotactic surgery. Methods: Stereotactic aspiration using a multitrack technique was performed in 20 patients with ganglionic hemorrhages perforating into the subcortex. Using 3-dimensional computed tomography (3D-CT) guidance, the trajectories and targets of hematoma drainage were selected to extract most portions of the irregular and expansive intracerebral hematomas. Volumes ranged from 36 to 60 mL (mean, 45 mL). Four to 5 drains were inserted into the parenchymal and ventricular clots. Aspiration and injections of urokinase (5000 IU) were repeated every 2 to 3 hours until the hematoma was almost completely removed. Results: The intended catheters for hematoma aspiration were placed precisely along the predetermined tracks with the aid of 3D-CT visualization. The deep and subcortical hematomas were totally removed within a mean of 10 hours postoperatively. Multiple catheter placements itself caused no complications. Sixteen patients (80%) recovered with a favorable neurological outcome. Conclusions: The 3D-CT–based multitrack technique is a rapid and effective method for the stereotactic removal of extensive ganglionic hemorrhages. It has the advantage of giving better neurological recovery than conventional stereotactic or microscopic surgery for selected patients. D 2005 Elsevier Inc. All rights reserved. Keywords: Intracerebral hemorrhage; Stereotactic aspiration; Putaminal hematoma; Fibrinolysis; 3-Dimensional computed tomography; Angiography