Stereotactic evacuation and local administration in intracerebral haematomas. A comparative study

Based on current controversies on optimal treatment for spontaneous intracerebral haematomas, chronic experiments to investigate the validity of open surgery, stereotactic evacuation and local urokinase administration in these lesions were performed in 52 dogs. Under general anesthesia diverse volumes of autologous blood were intracerebrally injected to produce the haematoma. A catheter was introduced and chronically implanted in the contralateral ventricle for intracranial pressure monitoring. The animals were divided in two groups of 26 dogs each, according to haematoma location in subcortical or basal ganglia structures. The natural history was studied in both groups. Different types of treatment consisting in surgery, stereotactic evacuation, urokinase injection within the clot and both latter techniques combined were carried out 24 or 72 hours following haematoma production. Clinical status, systemic arterial pressure, intracranial pressure and CT scanning were used for result evaluation. Brain specimens were submitted for pathological examination. Our results indicate that stereotactic evacuation performed during the first 24 hours after haematoma occurrence was the most effective and innocuous procedure for basal ganglia lesions. Local urokinase plus stereotactic aspiration showed a high efficacy in controlling delayed basal ganglia and subcortical blood collections. Other therapeutic approaches behaved almost as the natural history.