Treatment of intraventricular hemorrhage with tissue plasminogen activator

Neurosurgery. 1993 Jun;32(6):941-7; discussion 947. doi: 10.1227/00006123-199306000-00010.


The patients with intraventricular hemorrhage (IVH) were treated with recombinant tissue plasminogen activator (rt-PA) injected directly into the lateral ventricles, followed by ventricular drainage. All had a decreased level of consciousness before treatment (Glasgow Coma Scale score 10 +/- 3.4). A total dose between 2 and 12 mg of rt-PA (6.4 +/- 3.3) was administered. For eight patients with aneurysmal IVH, treatment with rt-PA began with two patients the same day as the aneurysm clipping, and the day after with six patients. For a patient with an excision of a ruptured arteriovenous malformation and a patient with IVH resulting from a lateral ventricular catheterization during posterior fossa tumor surgery, treatment with rt-PA started 24 hours after surgery. After an injection of rt-PA, the ventricular drain was closed for 1 hour, followed by alternate-hourly drainage and intracranial pressure (ICP) monitoring. Five patients received a second injection of rt-PA on the second postoperative day, and one patient received a third dose on the third day. Among the eight patients given rt-PA the day after surgery, the volume of external cerebrospinal fluid (CSF) drainage for 24 +/- 8 hours before treatment was 61 +/- 57 ml, and the mean ICP was 22 +/- 5 mm Hg during this same time. Younger age and poorer neurological condition correlated with higher ICP before treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

MeSH terms

  • Adolescent
  • Aged
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / therapy*
  • Cerebral Ventricles* / drug effects
  • Cerebrospinal Fluid Shunts
  • Female
  • Humans
  • Injections, Intraventricular
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / surgery
  • Intracranial Pressure / drug effects
  • Male
  • Middle Aged
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / therapy
  • Recombinant Proteins / administration & dosage
  • Tissue Plasminogen Activator / administration & dosage*
  • Tomography, X-Ray Computed


  • Recombinant Proteins
  • Tissue Plasminogen Activator