Korean J Neurotrauma.  2019 Oct;15(2):103-109. 10.13004/kjnt.2019.15.e32.

Delayed Operation of Acute Subdural Hematoma in Subacute Stage by Trephine Drainage using Urokinase

Affiliations
  • 1Department of Neurosurgery, Kwangju Christian Hospital, Gwangju, Korea. damianus1@naver.com

Abstract


OBJECTIVE
The principle operation of acute subdural hematoma (ASDH) is a craniotomy with hematoma removal, but a trephination with hematoma evacuation may be another method in selected cases. Trephine drainage was performed for ASDH patients in subacute stage using urokinase (UK) instillation, and its results were evaluated.
METHODS
Between January 2016 and December 2018, the trephine evacuation using UK was performed in 9 patients. The interval between injury and operation was from 1 to 2 weeks. We underwent a burr hole trephination with drainage initially, and waited until the flow of liquefied hematoma stopped, then instilled UK for the purpose of clot liquefaction.
RESULTS
The mean age of patients was 71.6 years (range, 38-90 years). The cause of ASDH was trauma in 8 cases, and supposed a complication of anticoagulant medication in 1 case. Four out of 8 patients took antiplatelet medications and one of them was a chronic alcoholism. The range of the Glasgow Coma Scale score before surgery was from 13 to 15. Most of patients, main symptom was headache at admission. The Glasgow Outcome Scale score was 5 in 8 cases and 3 in 1 case.
CONCLUSION
It is thought to be a useful operation method in selected patients with ASDH that the subdural drainage in subacute stage with UK instillation. This method might be another useful option for the patients with good mental state regardless of age and the patients with a risk of bleeding due to antithrombotic medications.

Keyword

Acute subdural hematoma; Chronic subdural hematoma; Urokinase; Trephination

MeSH Terms

Alcoholism
Craniotomy
Drainage*
Glasgow Coma Scale
Glasgow Outcome Scale
Headache
Hematoma
Hematoma, Subdural, Acute*
Hematoma, Subdural, Chronic
Hemorrhage
Humans
Methods
Trephining
Urokinase-Type Plasminogen Activator*
Urokinase-Type Plasminogen Activator
Full Text Links
  • KJN
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
    DB Error: unknown error