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V.V. Krylov1,2, S.A. Burov3, V.G. Dashian1,2, I.E. Galankina1
1 Scientific Research Institute of Emergency Care named after N.V Sklifosovsky, Moscow, Russian Federation 2 Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Russian Federation 3 Central Clinical Military Hospital FSS, Moscow, Russian Federation
Local Fibrinolysis in Surgical Treatment of Non-Traumatic Intracranial
Hemorrhages
More than 70% of hypertensive hemorrhages are located in deep brain structures. The removal of such hematomas using encephalotomy is accompanied by additional cerebral trauma and often results in unsatisfactory outcomes. The puncture aspiration with local fibrinolysis is one of the minimal invasive methods for treatment of intracerebral hematomas (ICH). The puncture and aspiration of liquid part of ICH (not more than 20% of ICH volume) is performed via small burr hole. Afterward the catheter is placed into ICH cavity and fibrinolytic is injected via this catheter in postoperative period for lysis of ICH solid part. The lysed blood is aspirated within 14 days. The last generations of fibrinolytics are very effective concerning intensity of blood clot lysis and practically have no systematic effect on blood coagulation system during their local usage. Morphological examinations showed that usage of fibrinolysis leads to formation of smaller cysts in the region of former hematoma as well as reparative processes in perihemorrhagical zone are expressed better comparing with treatment methods without usage of fibrinolytics. The morphological pattern is also confirmed by clinical signs of neurological deficit regress corresponding to damage focus. We operated 124 patients with parenchymal hemorrhages and 28 patients with intraventricular hemorrhages using described minimally invasive method at the base of Scientific Research Institute of Emergency Care n.a. N.V. Sklifosovsky. The applied method allowed decreasing lethality from 35% to 21% among patients with parenchymal ICH and from 98% to 48% among patients with ventricular hemotamponade underwent usage of ventricular drainage combined with local fibrinolysis. Key words: hemorrhagic stroke, local fibrinolysis, surgery of intracerebral hemorrhages.
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1. .., .., .., . . . 2006; 3: 412.
2. .., .. . . . 1975. 533 .
3. Schmutzler R., Koller F. Die Thrombolyse-Therapie. Erg. Inn. Med. Kinderheilkї. 1965; 22: 157210.
4. Wardlaw J.M., Warlow C. Thrombolysis in acute ischaemic stroke: does it work? Stroke. 1992; 23: 1826-1839.
5. Bousser M.G., Chiras J., Bonas I., Castaigne P. Cerebral venous thrombosis: A review of 38 cases. Stroke. 1985; 16: 199-213.
6. Matsumoto K., Hondo H. CT-guided stereotaxic evacuation of hypertensive intracerebral hematomas. J. Neurosurg. 1984; 3: 440-448.
7. .., .. . - II . . 1998. . 193-194.
8. .., . ., .., .. . .: ; . 2009. 160 .
9. .. . : . 2009. 288 .
10. .., .. - , . . 2004; 3: 51-55.
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12. .., .., .., - .. . . . .. . 2012; 6 (76): 3-12.
13. Deleuze A.J., Orliaguet G.A., Meyer P.G., Blanot S., Zerah M., Carli P.A. Intraventricular fibrinolysis for post-traumatic intraventricular hemorrhage in a child with multiple injuries. Intensive Care Med. 2000; 26 (10): 1579-1580.
14. Mizoi K., Yoshimoto T., Takahashi A., Fujiwara S., Koshu K., Sug-awara T. Prospective study on the prevention of cerebral vasospasm by intrathecal fibrinolytic therapy with tissue-type plasminogen activator. J. Neurosurg. 1993; 78: 430-437.
15. Niewkamp D.J., de Gansk, Renkelg J. Treatment and outcame of severe intraventricular extension in patients with subarachnoid or intracerebral hemorrhage: systematic review of the literature. Neurology. 2000; 247: 117-121.
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17. .. . . . . 1999; 25 (8): 563-571.
18. Qureshi A.I., Luft A.R., Sharna M., Guterman L.R., Horkins L.N. Prevention and treatment of tromboembolic and ischemic complications associated with Endovacular Procedures: Part I Pathophysiological and pharmocological Features. Neurosurgery. 2000; 46 (6): 1344-1359.
19. .., .. . . . . . . 2000; 1: 6-10.

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: 129010, , . , . 3, .: (495) 621-53-22, e-mail: manuscript@inbox.ru
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