Safety and efficacy of stereotactic aspiration with fibrinolysis for deep-seated spontaneous intracerebral hemorrhages: A single-center experience

Objective: The aim of this study was to evaluate feasibility and safety of stereotactic aspiration with fibrinolysis of deep-seated intracerebral hemorrhages (ICH).
Materials and methods: From March 1995 until December 2016, 58 adult patients (34 men and 24 women; mean age of 56.8 ± 11.8 years) presenting with deep-seated spontaneous supratentorial ICH were treated using a minimally invasive technique. Intracerebral hematomas were aspirated until obvious resistance to free-hand suction and subsequent clot fibrinolysis was done using either streptokinase or recombinant tissue-type plasminogen activator. CT scans were performed at intervals ranging from 24 to 72 h. At discharge, functional outcomes were evaluated using the Glasgow outcome scale (GOS). The 30-day mortality rate was evaluated in all patients.
Results: The average ICH volume on initial CT scan was 34.7 ± 11.1 cm³ (range, 20–90 cm³). Mean residual hematoma volume after the treatment was 8.0 ± 5.1 cm³ (range, 3–32 cm³). There was statistically significant reduction of ICH volume after the treatment (P < 0.001). Median ICH reduction rate was 5 cm³/d (range, 1.5–16.0 cm³/d) and 17.2%/d (range, 5.27– 40.0%/d). Median discharge GOS score was 3 (range, 1–4). Six (10.9%) patients died during the 30-day follow-up period. Treatment related complications were observed in three (5.5%) patients. In two patients asymptomatic increase of ICH volume occurred and one patient was diagnosed with CNS infection.
Conclusions: Stereotactic clot aspiration with subsequent fibrinolytic therapy is safe and feasible treatment procedure associated with significant hematoma resolution rates and acceptable patient outcomes.