A treatment option for severe cerebellar hemorrhage with ventricular extension in elderly patients: intraventricular fibrinolysis

J Neurol. 2014 Feb;261(2):324-9. doi: 10.1007/s00415-013-7198-2. Epub 2013 Dec 3.

Abstract

External ventricular drainage (EVD) combined with intraventricular fibrinolysis (IVF) is rarely used in severe spontaneous cerebellar hemorrhage (SCH) with intraventricular hemorrhage (IVH). Recently, the treatment strategy was repeatedly performed in our hospital to elderly patients with severe SCH + IVH. To analyze its clinical value, we compared it to two treatment strategies which now commonly are used for these patients: conservative management (CM) and clot evacuation (CE). In this study, a total of 118 cases were observed, of which 28 cases received CM, 43 cases received EVD + IVF and 47 cases received CE. The Glasgow Coma Scale score, frequency of complication, mortality in one month, modified Rankin Scale (mRS) at six months, and causes of death were analyzed. The outcomes of patients in the CM group were extremely poor compared to patients undergoing surgery (P = 0.034) and the mortality was up to 61.3 % (18/28), which was much higher than those of the two surgical groups (P = 0.026). No significant difference was found in mortality and mRS between the two surgical groups (P > 0.05). Patients in the CE group mostly died of deterioration of comorbidities and postoperative complications, whereas more deaths occurred in the CM group and the EVD + IVF group due to rebleeding, brainstem compression, perilesional edema and tight posterior fossa (χ (2), P = 0.006). It is suggested that EVD + IVF is a treatment option for elderly patients with severe SCH + IVH.

MeSH terms

  • Aged
  • Analysis of Variance
  • Cerebellar Diseases / drug therapy*
  • Cerebellar Diseases / mortality
  • Cerebellar Diseases / pathology
  • Cerebral Hemorrhage / drug therapy*
  • Cerebral Hemorrhage / mortality
  • Cerebral Hemorrhage / pathology
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Fibrinolytic Agents / therapeutic use*
  • Glasgow Coma Scale
  • Hematoma / pathology
  • Humans
  • Injections, Intraventricular
  • Male
  • Middle Aged
  • Plasminogen Activators / administration & dosage
  • Plasminogen Activators / therapeutic use
  • Thrombolytic Therapy / methods*
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Urokinase-Type Plasminogen Activator / administration & dosage
  • Urokinase-Type Plasminogen Activator / therapeutic use

Substances

  • Fibrinolytic Agents
  • Plasminogen Activators
  • Urokinase-Type Plasminogen Activator