[Removal of hypertensive intracerebral hematoma with stereotactic aqua-stream and aspirator (SAS & A)].

The stereotactic aqua-stream and aspirator (SAS & A) was a modification of the aqua-stream and aspirator (AS & A) in order to remove hypertensive intracerebral hematoma. The newly designed needles were held with an adaptor to any kind of Leksell's, Patil's, UT's, Sugita's, or Komai's stereotactic equipment. The needles were stereotactically inserted into the center of the hematoma cavity through a burr-hole. The needles were composed of an outer tube and two inner tubes. The inner tubes were arranged parallel with each other. One was an irrigation tube of 0.1 mm in inner diameter, the other was a suction tube of 2 mm in outer diameter. The blood clot was sucked through a window of the outer tube by the aspirator and incarcerated there soon after. The incarcerated blood clot was crushed by a small streak of saline solution from the nozzle of the irrigation tube. Crushed clot and fluid were sucked through the suction tube. The extent of evacuation of the hematoma was evaluated by CT scans during stereotactic surgery. In all 10 cases of hypertensive intracerebral hematoma, 73-98% of hematoma content was removed. Disturbances of consciousness recovered soon after the surgery. Aphasia and hemiparesis improved later. Hard clot could be removed completely and safely by this new instrument, SAS & A, at an early stage after a stroke, because of the crushing and washing action.