Stereotaxic evacuation of spontaneous intracerebral hematomas

The authors describe a new device for removal of intracerebral hematomas, based on the principle of stereotaxic evacuation of these lesions proposed in 1978 by Backlund and von Holst. The optimum parameters of stereotaxic aspiration, including speed of screw rotation and amount of suction, have been determined experimentally. Computerized tomography scanning was used to locate the hematoma site, to assess its volume, and to determine stereotaxic coordinates. A new method of preventing rebleeding is also described. This procedure was used to aspirate hematomas in 32 patients with spontaneous intracerebral hemorrhage, including one case caused by aneurysmal rupture and one secondary to rupture of an arteriovenous malformation. All patients were operated on in a severely comatose or semicomatose state. In all but four cases, the hematomas were almost totally removed. Three patients were operated on twice because of recurrent bleeding. The mortality rate for the series was 22%. A preliminary conclusion is made that this new method is safer and less traumatic than open surgery in most cases of severe intracerebral hematoma.