Korean J Neurotrauma.  2015 Oct;11(2):131-134. 10.13004/kjnt.2015.11.2.131.

Effects of Oral Streptokinase-Streptodornase on Remnant Chronic Subdural Hematomas

• Park M
• Kim JM
• Kim HJ

• KMID: 2378271
• DOI: http://doi.org/10.13004/kjnt.2015.11.2.131

Abstract

OBJECTIVE
In most cases, the postoperative course of a chronic subdural hematoma (CSDH) is good, but CSDHs sometimes remain after the inserted catheter is removed, and the outcomes of such remnant hematomas are unclear. As oral streptokinase-streptodornase (OSS) has anti-inflammatory and hematologic effects, we assessed the effects of OSS on remnant CSDHs through a retrospective analysis of clinical data.
METHODS
This study included 101 patients with traumatic CSDH who had remnant CSDH after burr-hole trephination with the closed drainage system between October 2009 and December 2012. We assessed the clinical outcomes, remnant CSDH volume, and recurrence rate from computed tomography scans in order to evaluate the effects of OSS.
RESULTS
No significant differences were found in the changes in remnant hematoma volume between the OSS-treated and non-treated groups (p=0.531). The reoperation rate because of was 5.4% (2 patients) in the OSS-treated group and 6.3% (4 patients) in the non-treated group. The number of patients requiring reoperation did not differ between the groups (p=0.658).
CONCLUSION
OSS treatment was not associated with a significant reduction in the remnant CSDH volume or recurrence rate after burr-hole drainage. Thus, there seems to be no basis for using OSS in CSDH patients.

Keyword

Hematoma, subdural, chronic; Recurrence; Streptodornase and streptokinase

MeSH Terms

Catheters
Drainage
Hematoma
Hematoma, Subdural, Chronic*
Humans
Recurrence
Reoperation
Retrospective Studies
Streptodornase and Streptokinase
Trephining
Streptodornase and Streptokinase

Reference

1. Abouzari M, Rashidi A, Rezaii J, Esfandiari K, Asadollahi M, Aleali H, et al. The role of postoperative patient posture in the recurrence of traumatic chronic subdural hematoma after burr-hole surgery. Neurosurgery. 2007; 61:794–797. discussion 797PMID: 17986941.

2. Alcalá-Cerra G, Young AM, Moscote-Salazar LR, Paternina-Caicedo A. Efficacy and safety of subdural drains after burr-hole evacuation of chronic subdural hematomas: systematic review and meta-analysis of randomized controlled trials. World Neurosurg. 2014; 82:1148–1157. PMID: 25118059.

3. Berghauser Pont LM, Dammers R, Schouten JW, Lingsma HF, Dirven CM. Clinical factors associated with outcome in chronic subdural hematoma: a retrospective cohort study of patients on preoperative corticosteroid therapy. Neurosurgery. 2012; 70:873–880. discussion 880PMID: 21937933.

4. Calandre EP, Ruiz-Morales M, Lopez-Gollonet JM, Hernandez MA, Guerrero JA, Ródenas E, et al. Efficacy of oral streptokinase-streptodornase in the treatment of ankle sprains. Clin Orthop Relat Res. 1991; 263:210–214. PMID: 1899636.

5. Chon KH, Lee JM, Koh EJ, Choi HY. Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien). 2012; 154:1541–1548. PMID: 22653496.

6. Ducruet AF, Grobelny BT, Zacharia BE, Hickman ZL, DeRosa PL, Anderson K, et al. The surgical management of chronic subdural hematoma. Neurosurg Rev. 2012; 35:155–169. discussion 169PMID: 21909694.

7. Hettich R, Schunack G. [Reabsorption of standardised intramuscular haematomas in rabbits treated with streptokinase per os (author's transl)]. Arzneimittelforschung. 1981; 31:306–308. PMID: 7194647.

8. Jeong SI, Kim SO, Won YS, Kwon YJ, Choi CS. Clinical analysis of risk factors for recurrence in patients with chronic subdural hematoma undergoing burr hole trephination. Korean J Neurotrauma. 2014; 10:15–21.

9. Jung YG, Jung NY, Kim E. Independent predictors for recurrence of chronic subdural hematoma. J Korean Neurosurg Soc. 2015; 57:266–270. PMID: 25932293.

10. Katavisto M. Streptokinase-streptodornase in the treatment of ulcus serpens corneae. Acta Ophthalmol (Copenh). 1956; 34:214–217. PMID: 13354339.

11. Markwalder TM. Chronic subdural hematomas: a review. J Neurosurg. 1981; 54:637–645. PMID: 7014792.

12. Mori K, Maeda M. Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo). 2001; 41:371–381. PMID: 11561347.

13. Oh HJ, Lee KS, Shim JJ, Yoon SM, Yun IG, Bae HG. Postoperative course and recurrence of chronic subdural hematoma. J Korean Neurosurg Soc. 2010; 48:518–523. PMID: 21430978.

14. Rohde V, Graf G, Hassler W. Complications of burr-hole craniostomy and closed-system drainage for chronic subdural hematomas: a retrospective analysis of 376 patients. Neurosurg Rev. 2002; 25:89–94. PMID: 11954771.

15. Rutter PM, Carpenter B, Hill SS, Locke IC. Varidase: the science behind the medicament. J Wound Care. 2000; 9:223–226. PMID: 11933332.

16. Sakakibara F, Tsuzuki N, Uozumi Y, Nawashiro H, Shima K. [Chronic subdural hematoma--recurrence and prevention]. Brain Nerve. 2011; 63:69–74. PMID: 21228450.

17. Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, et al. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet. 2009; 374:1067–1073. PMID: 19782872.

18. Sarnvivad P, Chiewchanvechakul W, Chumnanvej S. Chronic subdural hematoma: drainage vs. no drainage. J Med Assoc Thai. 2011; 94:1352–1356. PMID: 22256475.

19. Sherry S, Tillett WS, Read CT. The use of streptokinase-streptodornase in the treatment of hemothorax. J Thorac Surg. 1950; 20:393–417. PMID: 14774891.

20. Song DH, Kim YS, Chun HJ, Yi HJ, Bak KH, Ko Y, et al. The predicting factors for recurrence of chronic subdural hematoma treated with burr hole and drainage. Korean J Neurotrauma. 2014; 10:41–48.

21. Wakai S, Hashimoto K, Watanabe N, Inoh S, Ochiai C, Nagai M. Efficacy of closed-system drainage in treating chronic subdural hematoma: a prospective comparative study. Neurosurgery. 1990; 26:771–773. PMID: 2352594.

22. Weigel R, Hohenstein A, Schlickum L, Weiss C, Schilling L. Angiotensin converting enzyme inhibition for arterial hypertension reduces the risk of recurrence in patients with chronic subdural hematoma possibly by an antiangiogenic mechanism. Neurosurgery. 2007; 61:788–792. discussion 792-793PMID: 17986940.

23. Yoshii K, Seki Y, Aiba T. [Causative factors of recurrence of chronic subdural hematoma]. No Shinkei Geka. 1987; 15:1065–1071. PMID: 3323930.

24. Yu GJ, Han CZ, Zhang M, Zhuang HT, Jiang YG. Prolonged drainage reduces the recurrence of chronic subdural hematoma. Br J Neurosurg. 2009; 23:606–611. PMID: 19922274.