[Stereotactic evacuation of massive hypertensive intracerebral hemorrhage].

Six patients with massive hypertensive intracerebral hemorrhage and showing progression of consciousness-disturbance were treated by CT-guided stereotactic surgery. Serious complications or the age of these patients prevented evacuation of the hematomas by craniotomy under general anesthesia. The increase in the size of the intracerebral hematoma suggested by the progression of the consciousness-disturbance on admission was stopped by controlling the blood pressure. Stereotactic evacuation of the hematoma was performed using Komai's CT stereotactic apparatus 1-4 days after the onset. On the CT slice showing the maximum size of the hematoma, two target points showing each center or two circles which cover the greater part of the hematoma were determined, and then two drainage tubes were inserted into the two target points of the hematoma through two burr holes, and the hematoma was aspirated with a syringe. Postoperatively, every 12 hours, a solution of 60,000IU urokinase in 100 ml saline was irrigated into the hematoma cavity with aspiration of the hematoma, and finally 10 ml urokinase solution was left in the hematoma cavity. By 2-4 repetitions of this procedure, 83-91% of the estimated hematoma volume was evacuated using urokinase (120,000-240,000IU) for 1-2 days. Therefore, all of the cases showed improvement in the consciousness level without rebleeding or progression of serious complications. For large hypertensive intracerebral hematomas in aged patients or patients with serious complications, this stereotactic surgery can be carried out safely and rapidly through two drainage tubes using urokinase after 24 hours from the onset.