An early successful surgical treatment of fibrinolysis-related symptomatic intracerebral hemorrhage without procoagulant therapy.

Thrombolysis with recombinant tissue plasminogen activator (rt-PA) is clinically effective at treating acute ischemic stroke. However, the use of thrombolytic therapy is associated with an increased risk of symptomatic intracerebral hemorrhage (sICH). Whether unacceptable surgical hemorrhage occurs after emergent decompressive craniotomy during the first hours for sICH remains unknown. We report a 69-year-old Chinese woman with a fibrinolysis-related sICH, and discuss the efficacy and the safety of craniotomy in this setting. An urgent decompressive craniotomy was performed through a standard pterional approach without any procoagulant therapy before operation. No unacceptable surgical hemorrhage occurred during the first hours after onset of sICH, and the outcome of this patient is fairly good. Early urgent decompressive craniectomy in the treatment of fibrinolysis-related sICH may be a safe therapy, which may improve clinical outcomes.