{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T22:40:33Z","timestamp":1776724833312,"version":"3.51.2"},"reference-count":12,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1991,8]]},"abstract":"<jats:p content-type=\"fine-print\">\u2713 Fifteen patients undergoing surgery within 48 hours of aneurysm rupture were administered recombinant tissue plasminogen activator (rt-PA) directly into the basal subarachnoid cisterns after minimal surgical clot removal and aneurysm clipping. Preoperatively, 13 patients had diffuse or localized thick subarachnoid blood clots on computerized tomography (CT), and two had diffuse thin clots. The rt-PA was given as a single intraoperative injection of 7.5 mg (one patient), 10 mg (nine patients), or 15 mg (five patients). Postoperative cisternal drainage was employed in three patients.<\/jats:p>\n<jats:p content-type=\"fine-print\">All patients except one demonstrated partial to complete cisternal clot clearance on CT scans within 24 hours after surgery. The patient who showed no clot reduction was the only patient in this series to develop symptomatic vasospasm and was the only fatality, dying 8 days after rupture. No vasospasm was seen on follow-up cerebral angiography in six of the 14 responding patients, and mild-to-moderate arterial narrowing was seen in at least one major cerebral artery in the remaining eight patients. Severe angiographic vasospasm was not seen, although the patient who died did not undergo repeat angiography. There was one major complication early in the series which seemed clearly related to treatment, and that was a large extradural hematoma occurring within several hours of craniotomy. Intrathecal fibrinolytic treatment appears effective in clearing subarachnoid clot and reducing vasospasm, and may be associated with acceptable risks if given to patients with large-volume subarachnoid hemorrhages at high risk for severe vasospasm.<\/jats:p>","DOI":"10.3171\/jns.1991.75.2.0181","type":"journal-article","created":{"date-parts":[[2009,5,19]],"date-time":"2009-05-19T16:21:01Z","timestamp":1242750061000},"page":"181-188","source":"Crossref","is-referenced-by-count":119,"title":["Intracisternal recombinant tissue plasminogen activator after aneurysmal subarachnoid hemorrhage"],"prefix":"10.3171","volume":"75","author":[{"given":"J. Max","family":"Findlay","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryce K. A.","family":"Weir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neal F.","family":"Kassell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lew B.","family":"Disney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael G. A.","family":"Grace","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg","first-page":"985","article-title":"Report of World Federation of Neurological Surgeons Committee on a universal subarachnoid hemorrhage grading scale.","volume":"68","author":"Drake","year":"1988"},{"key":"b2","series-title":"Neurosurgery","first-page":"491","article-title":"Safety and efficacy of intrathecal thrombolytic therapy in a primate model of cerebral vasospasm.","volume":"24","author":"Findlay","year":"1989"},{"key":"b3","series-title":"Neurosurgery","first-page":"201","article-title":"The effect of timing of intrathecal fibrinolytic therapy on cerebral vasospasm in a primate model of subarachnoid hemorrhage.","volume":"26","author":"Findlay","year":"1990"},{"key":"b4","series-title":"Can J Neurol Sci","first-page":"28","article-title":"Intrathecal fibrinolytic therapy after subarachnoid hemorrhage: dosage study in a primate model and review of the literature.","volume":"16","author":"Findlay","year":"1989"},{"key":"b5","series-title":"J Neurosurg","first-page":"723","article-title":"Effect of intrathecal thrombolytic therapy on subarachnoid clot and chronic vasospasm in a primate model of SAH.","volume":"69","author":"Findlay","year":"1988"},{"key":"b6","series-title":"Acta Neurochir","first-page":"25","article-title":"Coagulation and fibrinolysis in blood and cerebrospinal fluid after aneurysmal subarachnoid haemorrhage: effect of tranexamic acid (AMCA).","volume":"56","author":"Fodstad","year":"1981"},{"key":"b7","series-title":"J Neurosurg","first-page":"224","article-title":"Effect of clot removal on cerebral vasospasm.","volume":"72","author":"Inagawa","year":"1990"},{"key":"b8","series-title":"Lancet","first-page":"480","article-title":"Assessment of outcome after severe brain damage. A practical scale.","volume":"1","author":"Jennett","year":"1975"},{"key":"b9","series-title":"Neurosurgery","first-page":"301","article-title":"Prevention of vasospasm by early operation with removal of subarachnoid blood.","volume":"10","author":"Mizukami","year":"1982"},{"key":"b10","series-title":"J Neurosurg","first-page":"505","article-title":"Nimodipine treatment in poor-grade aneurysm patients. Results of a multicenter double-blind placebo-controlled trial.","volume":"68","author":"Petruk","year":"1988"},{"key":"b11","series-title":"Neurosurgery","first-page":"590","article-title":"Efficacy of single intracisternal bolus injection of recombinant tissue plasminogen activator to prevent delayed cerebral vasospasm after experimental subarachnoid hemorrhage.","volume":"25","author":"Seifert","year":"1989"},{"key":"b12","series-title":"J Neurosurg","first-page":"622","article-title":"Effect of early operation for ruptured aneurysms on prevention of delayed ischemic symptoms.","volume":"57","author":"Taneda","year":"1982"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/75\/2\/article-p181.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/75\/2\/article-p181.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/75\/2\/article-p181.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,19]],"date-time":"2023-03-19T22:09:04Z","timestamp":1679263744000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/75\/2\/article-p181.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1991,8]]},"references-count":12,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/jns.1991.75.2.0181","relation":{},"ISSN":["0022-3085"],"issn-type":[{"value":"0022-3085","type":"print"}],"subject":[],"published":{"date-parts":[[1991,8]]}}}