Single Intracisternal Injection of Recombinant Tissue Type Plasminogen Activator for Prevention of Cerebral Vasospasm

We attempted to compare the clinical efficacy of three modalities evacuating clots from basal cisterns as following; simple cisternal drainage (D, N = 14), ventricular or cisternal irrigation combined with cisternal drainage (I, 13), and single intracisternal injection of recombinant tissue type plasminogen activator (rt-PA) with cisternal drainage (T, 26). The patients undergoing surgery within 48 hours of aneurysm rupture were randomly assigned into three groups. Delayed neurological deficit was significantly less frequent in T than D group (15.4% vs. 57.1%, p < 0.01). There was no significant difference between I and T groups. According to Glasgow Outcome Scale, T group had a significantly better outcome than D group (p < 0.01). Severe disability was more common in D group than T group (p < 0.01). In T group, 2 of 7 deaths were due to severe vasospasm (7.7%). The complication in T group was epidural hematoma occurring in 2 patients. Our results suggest that intraoperative injection of rt-PA with cisternal drainage is effective in reducing vasospasm and improving outcome of the patients with SAH.