Download PDF
CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2024; 13(02): 176-178
DOI: 10.1055/s-0043-1761427
Brief Report

Minimally Invasive Technique for Spontaneous Intraparenchymal Hemorrhage

Himanshu Raval 
1   Department of Neurosurgery, NHL Municipal Medical College, SVP Hospital Campus, Elisbridge, Ahmedabad, Gujarat, India
,
Kalpesh Shah
1   Department of Neurosurgery, NHL Municipal Medical College, SVP Hospital Campus, Elisbridge, Ahmedabad, Gujarat, India
,
Mona Bhatt
2   Medical Officer, Bhailal Hospital, Vadodara, Gujarat, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective The aim of this study was to introduce a cost-effective and less invasive method for the evacuation of intraparenchymal hemorrhage (IPH).

Background IPH in the presence or absence of intraventricular hemorrhage has severe morbidity and has almost 50% mortality whether the patient is managed surgically or medically. Development of minimally invasive surgical techniques offers better outcomes but requires the use of special instruments and a unique skill set that is costly and requires special training.

Method We inserted infant feeding tube within the hematoma via the left Kocher's burr hole. We instilled 40,000 IU of urokinase serially at an 8 hours interval for 3 days to evacuate the left gangliocapsular hematoma.

Result We have treated a 50 years old hypertensive male patient with left gangliocapsular IPH and right hemiparesis (power: ⅖ on admission). After a month, on follow-up, the patient was conscious and oriented with improved right hemiparesis (power: ⅘).

Conclusion This technique of evacuating hematoma is instrumental in peripheral centers in developing as well as under-developed countries where there are limited resources and a better outcome is expected with minimal morbidity.

Keywords

IPH - urokinase - MIS


Publication History

Article published online:
23 February 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Qureshi AI, Mohammad YM, Yahia AM. et al. A prospective multicenter study to evaluate the feasibility and safety of aggressive antihypertensive treatment in patients with acute intracerebral hemorrhage. J Intensive Care Med 2005; 20 (01) 34-42
    CrossrefPubMedGoogle Scholar
  • 2 Sindelar BD, Patel V, Chowdhry S, Bailes JE. A case report in hemorrhagic stroke: a complex disease process and requirement for a multimodal treatment approach. Cureus 2018; 10 (07) e2976
    PubMedGoogle Scholar
  • 3 Sutherland GR, Auer RN. Primary intracerebral hemorrhage. J Clin Neurosci 2006; 13 (05) 511-517
    CrossrefPubMedGoogle Scholar
  • 4 Morotti A, Goldstein JN. Diagnosis and management of acute intracerebral hemorrhage. Emerg Med Clin North Am 2016; 34 (04) 883-899
    CrossrefPubMedGoogle Scholar
  • 5 Flaherty ML, Woo D, Haverbusch M. et al. Racial variations in location and risk of intracerebral hemorrhage. Stroke 2005; 36 (05) 934-937
    CrossrefPubMedGoogle Scholar
  • 6 Juvela S, Kase CS. Advances in intracerebral hemorrhage management. Stroke 2006; 37 (02) 301-304
    CrossrefPubMedGoogle Scholar
  • 7 Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM. STICH II Investigators. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet 2013; 382 (9890): 397-408
    CrossrefPubMedGoogle Scholar
  • 8 Tan Q, Chen Q, Niu Y. et al. Urokinase, a promising candidate for fibrinolytic therapy for intracerebral hemorrhage. J Neurosurg 2017; 126 (02) 548-557
    CrossrefPubMedGoogle Scholar
  • 9 Hanley DF, Thompson RE, Rosenblum M. et al; MISTIE III Investigators. Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial. Lancet 2019; 393 (10175): 1021-1032
    CrossrefPubMedGoogle Scholar
  • 10 Hanley DF, Lane K, McBee N. et al; CLEAR III Investigators. Thrombolytic removal of intraventricular haemorrhage in treatment of severe stroke: results of the randomised, multicentre, multiregion, placebo-controlled CLEAR III trial. Lancet 2017; 389 (10069): 603-611
    CrossrefPubMedGoogle Scholar