|
Outcome analysis of intraventricular thrombolytic
therapy for intraventricular haemorrhage
MWY Lee, KY Pang, WWS Ho, CK Wong
Department of Neurosurgery, Pamela Youde Nethersole Eastern Hospital,
3 Lok Man Road, Chai Wan, Hong Kong
OBJECTIVES. To evaluate the outcome of intraventricular
thrombolytic therapy for intraventricular haemorrhage and to formulate
a safe and effective regimen.
DESIGN. Retrospective study.
SETTING. Regional neurosurgical centre, Hong Kong.
PATIENTS. Twenty-nine consecutive adult patients
who presented from November 1995 to November 1998 with non-traumatic
intraventricular haemorrhage (Graeb score, >=7) with no active
rebleeding risks from vascular abnormalities.
INTERVENTIONS. Fourteen consecutive patients received
intraventricular streptokinase via the external ventricular drainage,
and 15 consecutive patients received intraventricular urokinase
treatment.
MAIN OUTCOME MEASURES. Patient demographics, Glasgow
coma scale score, Graeb score, mortality rate, shunt rate, fever
response, infection rate, catheter blockage rate, and local and
systemic bleeding tendency. RESULT. The mean age of the 16 men and
13 women was 59 years (range, 14-76 years). The median Graeb score
for cases of intraventricular haemorrhage was 10 (range, 7-12).
There was no significant difference in terms of the Graeb score
distribution, total dosage, and duration of treatment between the
streptokinase and urokinase groups. More cases of fever were observed
in the streptokinase group, which could be due to its antigenicity.
The infection rate of the central nervous system was 3%, and the
shunt rate was 24%. The overall 1-month postoperative mortality
was 10%, which was related to a low preoperative Glasgow coma scale
score (<=4). No local rebleeding, systemic coagulopathy, or catheter
blockage occurred.
CONCLUSIONS. Intraventricular thrombolytic therapy
is a safe and effective method of managing intraventricular haemorrhage.
We suggest instilling 20 000 units urokinase intra-operatively,
followed by 20 000 units daily for about 3 days, except in cases
of vascular abnormality, bleeding tendency, and trauma.
Hong Kong Med J 2003;9:335-40
Key words: Cerebral ventricles; Drainage; Intracranial
hemorrhages; Thrombolytic therapy; Tomography, X-ray computed
|
