Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciencesВестник Российской академии медицинских наук0869-60472414-3545"Paediatrician" Publishers LLC16410.15690/vramn.v68i7.708NEUROLOGY AND NEUROSURGERY: CURRENT ISSUESАКТУАЛЬНЫЕ ВОПРОСЫ НЕВРОЛОГИИ И НЕЙРОХИРУРГИИLOCAL FIBRINOLYSIS IN SURGICAL TREATMENT OF NON-TRAUMATIC INTRACRANIAL HEMORRHAGESМЕТОД ЛОКАЛЬНОГО ФИБРИНОЛИЗА В ХИРУРГИИ НЕТРАВМАТИЧЕСКИХ ВНУТРИЧЕРЕПНЫХ КРОВОИЗЛИЯНИЙKrylovV. V.КрыловВ. В.
Russian Federation

PhD, Professor, RAMS academician, Head of Emergency Department of Neurosurgery Research Institute of Emergency Care N.V. Sklifosovsky, Head of the Department of Neurosurgery and neuroresuscitation, Moscow State University of Medicine and Dentistry named after A.I. Evdokimov Address: 129010, Moscow, B. Suharevskaya Square, 3; tel.: (495) 621-53-22

manuscript@inbox.ruBurovS. A.БуровС. А.
Russian Federation

PhD, Chief Neurosurgeon of The Central Military Clinical Hospital of the Russian Federal Security Service Address: 123182, Moscow, 1st Pekhotny lane 9/27; tel.: (499) 196-28-95

s_a_burov@mail.ruDash'yanV. G.ДашьянВ. Г.
Russian Federation

PhD, Professor, Department of Neurosurgery and neuroresuscitation, Moscow State University of Medicine and Dentistry named after A.I. Evdokimov Address: 129010, Moscow, B. Suharevskaya Square, 3; tel.: (495) 620-12-54

v485@bk.ruGalankinaI. E.ГаланкинаИ. К.
Russian Federation

PhD, Professor, Head of Department of Pathology, Research Institute of Emergency Care N.V. Sklifosovsky Address: 129010, Moscow, B. Suharevskaya Square, 3; tel.: (495) 621-98-07

manuscript@inbox.ruScientific Research Institute of Emergency Care named after N.V. Sklifosovsky, Moscow, Russian Federation Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow, Russian FederationНИИ скорой помощи им. Н.В. Склифосовского, Москва, Российская Федерация Московский государственный медико-стоматологический университет им. А.И. Евдокимова, Российская ФедерацияCentral Clinical Military Hospital FSS, Moscow, Russian FederationЦентральный клинический военный госпиталь ФСБ России, Москва, Российская ФедерацияScientific Research Institute of Emergency Care named after N.V. Sklifosovsky, Moscow, Russian FederationНИИ скорой помощи им. Н.В. Склифосовского, Москва, Российская Федерация19072013687Vestnik Rossiiskoi akademii medetsinskikh nauk / Annals of the Russian academy of medical sciencesВестник Российской академии медицинских наук243107082015Copyright ©; 1970, "Paediatrician" Publishers LLCCopyright ©; 1970, Издательство "Педиатръ"1970"Paediatrician" Publishers LLCИздательство "Педиатръ"https://vestnikramn.spr-journal.ru/jour/about/submissionshttps://vestnikramn.spr-journal.ru/jour/article/view/164

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 1-4 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.

Более 70% гипертензивных кровоизлияний располагаются в глубинных отделах головного мозга. Удаление этих гематом путем энцефалотомии сопровождается дополнительной травматизацией мозга, и часто неудовлетворительными результатами. Одним из малотравматичных методов эвакуации внутримозговых гематом (ВМГ) является пункционная аспирация и локальный фибринолиз. Через небольшое трепанационное отверстие ВМГ пунктируют и аспирируют жидкую часть, которая составляет не более 20%. В полости гематомы оставляют катетер, через который в послеоперационном периоде вводят фибринолитик, растворяющий плотную часть гематомы. Лизированную кровь аспирируют в течение 1-4 суток. Последние поколения фибринолитиков очень эффективны в плане интенсивности растворения сгустка крови и практически не обладают системным воздействием на свертывающую систему крови при локальном применении. Морфологические исследования показали, что при использовании фибринолиза в области бывшей гематомы формируется киста меньшего размера, а репаративные процессы в зоне, окружающей гематому, выражены лучше, чем в случаях лечения без использования фибринолитиков. Морфологическая картина соответствует и клиническим данным о регрессе неврологической симптоматики, соответствующей очагу поражения. В институте скорой помощи им. Н.В. Склифосовского прооперированы 124 пациента с паренхиматозными кровоизлияниями и 28 – с вентрикулярными. Метод позволил снизить летальность с 35 до 21% при паренхиматозных ВМГ и с 98 до 48% при сочетании дренирования желудочков с локальным фибринолизом у больных с вентрикулярной гемотампонадой.

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