Comparison of Frame-Based and Frameless Stereotactic Hematoma Puncture and Subsequent Fibrinolytic Therapy for the Treatment of Supratentorial Deep Seated Spontaneous Intracerebral Hemorrhage

Abstract

Objective: This study compared the technical implications and clinical outcome of patients treated for an intracerebral hemorrhage using two minimally invasive procedures: frame-based stereotactic hematoma aspiration and frameless navigation-guided hematoma aspiration followed by fibrinolysis.

Methods: Thirty patients with a spontaneous supratentorial intracerebral hemorrhage, which was treated by a frame-based (n=15) and frameless (n=15) hematoma aspiration followed by subsequent fibrinolysis with urokinase, were retrospectively reviewed. The data for the two subsets of patients were analyzed with regard to hematoma reduction, Glasgow Coma Scale (GCS), and degree of weakness.

Results: In the frame-based stereotactic hematoma aspiration group, the volume of the hematoma was 15.4-100.0 mL (mean: 40.7±24.4), the GCS upon admission was 4-15 (mean: 10.1±3.0), and the grade of weakness upon admission was 1-5 (mean: 2.1±0.9). On the other hand, in the frameless navigation-guided hematoma aspiration group, the hematoma volume was 15.2-62.0 mL (mean: 30.0±15.2), the GCS upon admission was 7-15 (mean: 13.0±2.4), and the grade of weakness upon admission was 1-4 (mean: 2.3±1.2). The drainage catheter was in place for a mean duration of 5.1±2.4 days (range: 1-12 days). In the frame-based group, the initial hematoma was reduced by -115-88.5% (mean: 52±31.5) immediately after surgery, and 90.5% (41-100%) of the initial volume 14 days after surgery. In the frameless group, the initial hematoma was reduced by 11.7-90.8% (mean 57.3±25.1) immediately after surgery and 95.8% (87.7-100%) 14 days after surgery. The GCS score and the degree of weakness were evaluated 14 days after surgery, and the Glasgow outcome scale (GOS) score was evaluated at discharge. There were no statistically significant differences between the two groups.

Conclusion: The frame-based group and the frameless group followed by fibrinolysis had similar outcomes, and both procedures effectively reduced the intracerebral hemorrhage volume within a short period of time. In addition, these procedures are simple, precise, safe, and brief with a very low rebleeding rate and mortality.

Key words

Intracerebral hemorrhage - frame-based stereotaxy - frameless stereotaxy - fibrinolytic therapy

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