CT Fluoroscopy-guided Aspiration of Intracerebral Hematomas: Technique and Outcomes

CT Guided Catheter Aspiration & Thrombolysis of Hypertensive Basal Ganglionic Hematomas: Technique and Short-Term Outcome Comparison CT guided catheter thrombolysis of ICH

BACKGROUND

Minimally invasive techniques of hematoma evacuation with or without the use of thrombolytic agents to lyse the clots have shown promising outcomes against open surgical evacuation. However, there is a dearth of literature in developing nations.

OBJECTIVE

To evacuate spontaneous hypertensive basal ganglionic haemorrhages using CT guided catheter insertion, hematoma aspiration and lysis with thrombolytic agents and analyse the efficacy and outcomes.

METHODOLOGY

Ten patients with spontaneous basal ganglionic haemorrhage underwent CT guided clot catheter insertion, followed by aspiration of hematoma and clot lysis using 25000 IU urokinase instilled every 12 hours. Details including symptoms, clinical and radiological findings, efficacy of the technique, functional outcomes during follow-up, length of stay and cost were recorded. Relevant details for 12 age and sex-matched conservatively treated patients were compared.

RESULTS

Functional outcome in the catheter group at six months was better than the medically managed group, with improved mean Glasgow outcome scale (+0.4 vs +0.08), reduced modified Rankin score (-0.8 vs -0.25), and reduced National Institute of Health Stroke Scale scores (-6.8 vs -1.5 points). However, it was not statistically significant. Average hematoma volume reduction in catheter group was 83.14%. In the medically managed group, 2 of 12 patients(16.6%) had hematoma expansion, 6 patients(50%) developed hydrocephalus, and 2 patients(16.6%) died. In the catheter group, 4 patients of 10(40%) developed mild pneumocephalus that resolved.

CONCLUSION

The evacuation of hypertensive basal ganglionic hematomas is feasible with basic neurosurgical instruments and existing resources such as CT scan with improved functional outcome compared to conservative treatment alone.

Trajectories for Freehand-Guided Aspiration of Deep-Seated Spontaneous Intracerebral Hemorrhage

OBJECTIVE

Although external landmarks and trajectories for external ventricular drainage have been described for the freehand-guided method, no standard trajectory has been reported for deep-seated intracerebral hemorrhage (ICH). This article presents a freehand-guided catheter insertion technique for deep-seated spontaneous ICH using external landmarks.

METHOD

Freehand-guided hematoma aspiration using Kocher's point and the external auditory canal as landmarks was performed in 32 patients with a diagnosis of spontaneous ICH in basal ganglia treated between May 2015 and July 2018 at the author's institute.

RESULTS

In computed tomographic images, the mean actual to planned catheter tip distance was 16.1 ± 7.7 mm, the mean right-left deviation was 4.6 ± 5.2 mm, the mean anterior-posterior deviation was 11.1 ± 9.5 mm, and the mean superior-inferior deviation was 8.7 ± 4.4 mm. On largest hematoma slice, the mean distance from hematoma centers to inserted catheter was 9.8 ± 4.9 mm, and the mean horizontal and vertical distances were 4.0 ± 4.7 mm and 7.7 ± 4.8 mm, respectively. In 29 of the 32 patients, all the catheter holes contacted hematomas, whereas in the other 3 patients, 1 or more holes were in contact with brain parenchymal tissue.

CONCLUSION

For patients with basal ganglia hemorrhage, freehand-guided catheter insertion and hematoma aspiration with subsequent fibrinolysis is a feasible procedure that shortens procedural times. The described technique could be used as an alternative method because it can be performed when the patient is in a critical state without additional equipment.