Efficacy of Urokinase Cisternal Irrigation Therapy for Severe Subarachnoid Hemorrhage

We analyzed the efficacy of cisternal irrigation therapy by Urokinase (UKI) in cases with severe subarachnoid hemorrhage. Forty-two patients with ruptured aneurysms were operated on within 24 hours after subarachnoid hemorrhage. The clinical grading (Hunt & Kosnik) was III to IV in this series, and the CT grading (Fisher classification) was III to IV excluding cases with parenchymal hematoma. All patients were treated with hemodilution & normo-hypervolemic therapy postoperatively. Twenty-five were treated with UKI, and seventeen without UKI. There were complications in three patients treated with UKI, and UKI was stepped in mid course. In fourteen (63.3%) of the patients treated with UKI, CT showed that perimesencephalic cisternal clots were dissolved within three days after subarachnoid hemorrhage (A-group). In the other eight patients, the cisternal clots were dissolved within seven days (B-group). But insular cisternal clots tended to remain in spite of UKI. Symptomatic vapsospasm was recognized in 50% of the A-group, 75% of the B-group, and 94.1% of patients treated without UKI. Among the A-group, especially in H & K grade III, symptomatic vasospasm was minimal if it was recoginized clinically. There was no significant differences between the patients of B-group and patients without UKI, especially in H & K grade IV. The duration of UKI treatment was not correlated to the rate of symptomatic vasospasm. On the Glasgow Outcome Scale, the rate of good and moderate disability was 71.4% of A-group, 50.0% of the B-group, and 47.1% of the group untreated with UKI. We consider that UKI is beneficial in the prevention of symptomatic vasospasm, and that it is important and contributory factor in preventing the development of delayed ischemia to dissolve and reduce subarachnoid clots within three days.