Acta Neurochirurgica (2025) 167:202
Low-dose intraventricular tPA (1 mg every 8 hours for up to 3 doses) via EVD after aneurysmal subarachnoid hemorrhage significantly accelerated subarachnoid blood clearance without hemorrhagic or infectious complications, but did not reduce shunt dependency. Larger studies are needed to assess effects on delayed cerebral ischemia.
• Low-dose intrathecal tPA (1 mg every 8 hours for up to 3 doses via EVD) was administered to 8 aSAH patients after aneurysm coiling to enhance subarachnoid blood clearance.
• Significant blood clearance was achieved: mean Hijdra Sum Score (HSS) reduction was 81.1% within 3 days, compared to 41.3% in a prior natural history cohort (p = 0.001).
• No patients experienced hemorrhagic complications or ventriculitis following IT-tPA treatment.
• Two patients (25%) developed delayed cerebral ischemia (DCI) and radiographic vasospasm, which is lower than historical rates (47.9%).
• Most patients (75%) required ventriculoperitoneal shunt placement, a higher rate than institutional averages.
• IT-tPA was well tolerated and effective for rapid clot clearance, but the impact on clinical outcomes like DCI prevention and shunt dependency remains unclear due to small sample size.
• Further randomized controlled trials are needed to determine optimal dosing, timing, and clinical benefits of IT-tPA for aSAH patients.
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