Neurological recovery in 80 cases of rapid stereotactic evacuation and local fibrinolysis in spontaneous hematomas of putamen and thalamus

Introduction: Stereotactic evacuation and local fibrinolysis play a definite role in the treatment of spontaneous hematomas of putamen and thalamus. We examined the neurological recovery during the first week after early and effective release of the hematoma. Methods: From 1988-1996 we treated 80 patients with spontaneous hematomas (putaminal 56, thalamic 24). Associated intraventricular hemorrhage in 44 cases. Mean age 58 years. Mean volume of hemorrhage was 38 ml (without intraventricular portion). Patients older than 70 years were not operated. Patients with acute herniation-signs were operated through open craniotomy. Micro-stereotactic system according to Lerch. Fibrinolysis by Urokinase. Results: In 87% of cases a reduction of bleeding volume of 90% was reached. In most cases 36 h of fibrinolysis are sufficient. 7 days after operation we stated: treatment dependent mortality 2.5% and morbidity 5%, improvement of consciousness 54% (mean elevation of Glasgow-Coma-Scale 4 points), improvement of focal neurologic deficit 42% (mainly hemiparesis, aphasia). The earlier the hemorrhage evacuation (minimum interval was 6 hours after bleeding) the better was the neurologic recovery. Conclusion: Under conservative treatment more than a stabilisation of the patients condition is generally not possible during the first week, many patients even worsens during the first days. Stereotactic fibrinolysis allows of the patients a markedly recovery during the first week and reduce the duration and extent of intensive care. Complication rate lies under 8% and can be reduced in future. Mortality of operated patients is lower than in comparable conservatively treated groups.