Massage of a Hematoma to Assist in Decreasing the Volume of an Intraparenchymal Hemorrhage

Spontaneous intracerebral hemorrhage (ICH) is one of the least treatable types of stroke, and its incidence and all-age mortality have increased over the last several decades in China. Surgical evacuation using standard craniectomy for supratentorial hematoma is always controversial. How to ensure effective decreasing of intracranial pressure (ICP) is crucial to the management of ICH. A 48-year-old right-handed woman was brought to our hospital by her family, who stated that the woman could not speak well and had developed sudden left-sided weakness three hours previously. The patients were diagnosed with supratentorial bilateral intraparenchymal hemorrhages, mainly in the putaminal area. After inserting a catheter into the hematoma, we began to perform the maneuver of massage through the catheter by frequently using multiple 2 mL quantities of normal saline and performing the injecting-aspiration maneuver. After performing this massage repeatedly for 15 min, we terminated the operation. After the patient was admitted to the ICU, urokinase (40,000 U) was administered through the catheter every 12 hours for three days. After the patient stayed for an additional 11 days, she was discharged home. Minimally invasive surgery with massage techniques followed by thrombolytic evacuation of clots will be a new method for treating ICH patients.