Stereotactic Neuronavigation Guided Catheter Evacuation Of Spontaneous Cerebral Intraparenchymal Hemorrhage And Intracavitary Instillation Of Alteplase At The AKUH: A Case Series

Abstract

Introduction: Publication of MISTIE phase two and three trials sparked an interest in pursuing minimally invasive surgical procedures for managing spontaneous supratentorial intraparenchymal hemorrhage. It is established that volume reduction of the clot was faster surgically than that of medical management. Better outcomes based on mRS scores, shorter hospital stay and lower cost of care were also observed with more complete hematoma evacuations. We present our experience with stereotactic guided catheter evacuation and outcomes data using the mRS at 6 months. Methodology: We present a case series of neuronavigation guided catheter evacuation of supratentorial hemorrhagic stroke at AKUH and report the mRS outcome data at 6 months. All patient after with spontaneous intraparenchymal/intraventricluar hemorrhagic strokes underwent evaluation with CT brain and CT cerebral angiography. Only non-lesional patients with deep hematomas underwent 10French neuronavigation guided aspiration and post op instillation of 1 mg alteplase thrice daily and once daily 30 mg Vancomycin to a maxium of 9 doses. Results: Sixteen (16) patients were treated with the catheter based method with average hematoma volume evacuation of more than 90% achieved (range 45-95%_ within 36 hours range from 1- 4.2 days. The 6 month mRS score was good (0-2) in 11 68%, n=11 of the patients. 2 patients 12.5% n=2 suffered septic complications and one demised as result(6.25%) Conclusion: Catheter based treatments are effective and feasible.  A larger study to establish the long-term outcome of patients managed with this MIS surgical strategy compared to standard medical management and craniotomy for moderate to large ICH are required. We are limited in this study by its retrospective nature and low patient volumes.