Clinical Study On Microinvasive Treatment Of Hypertensive Intracranial Hematomas With Drainage Plus Urokinase

Objective: To explore the clinical value of drainage enhanced by urokinase in microinvasive treatment of hypertensive intracerebral hemorrhage( HICH).Methods: This study was divided into two parts.In first part, sixty-nine patients with hypertensive intraventrical hemorrhage, in whom external ventricular drainage was indicated, were divided into drainage-only group (Group 1 with 30 cases) and drainage plus urokinase group (Group 2 with 36 cases). Frontal horn ventriculostomies and catheter placement were performed through a frontal twist drill hole under local anesthesia and CT scanning was repeated imediatedly after the operations to ensure the position of catheter tip in ventricle. UK (20,000 IU) in 5 ml of normal saline solution was injected in ventricle of patients in Group 2 through catheter every 8 hours and catheter was closed for 2h, followed by 2h reopening of catheter. Drainage and closure of catheter alternated every 2 hours. The ventricular catheters were removed when patients no longer had symptomatic intracranial hypertension and/or CT scan did not show persistent intraventricular blood. The persistent ventricular drainage was performed in patients of Group 1. The resolution of intraventricular hemotoma monitored with CT and ADL scores were compared between the two groups.In second part, 117 patients with hypertensive intracerebral hemotoma (ICH) were divided into surgical treatment group (n=67) and conservative treatment group (n=50). Eligibility criteria for this protocol consisted of supratentorial ICH without brain stem compression, symptoms onset≥4 hours, age≥18 years, 30 to 70 ml of hematomas volume on CT scan, and Glasgow Coma Scale (GCS) score≥5 at admission. In surgical treatment group, the hypertensive intracerebral hematomas were lysed with urokinase drained through catheter placed by a burrhole, and conservative group were treated by traditional medication. CT scans were repeated at 1, 3, 5, 7, 10, 12, 14, 21 and 30d after treatment initiated. The resolution of ICH monitored with CT and GOS were compared between the two groups.Results:In the first part, the resolution of intraventricular blood clots in Group 2 was significantly faster than that of Group 1 (P=0.030). Prognosis of patients in Group 2 was much better than that of Group 1(P=0.029). No complications related to UK were observed. In the second part, compared with conservative treatment group, the absolute mean volume of ICH in surgical treatment groups were significant decreased (F=563.378, P<0.001). There were significant differences in hematoma volume between two groups at either time-piont. The resolution of ICH in surgical treatment group was quicker than that of conservative treatment group(P<0.001). In surgical treatment group, the hematomas volume were significant decreased at first day after operation and the hematoma was completely evacuated on 14d, while the complete resolution of ICH in conservative treatment group required 30 days. The prognosis evaluated by Glasgow Outcome Scale scores performed 3 months later in surgical treatment group was much better than that of conservative treatment group.Conclusion:1. UK can accelerate the resolution of hypertensive intracranial hemotoma.2. Drainage plus UK is an effective, safe and microinvasive modality for treatment of hypertensive intraventricular and intracerebral hematoma.