Fibrinolytic-Facilitated Chronic Subdural Hematoma Drainage—A Systematic Review

O, Yip Mang; Tsang, Shek Long; Leung, Gilberto Ka Kit

doi:10.1016/j.wneu.2021.03.029

Cited by 8 publications

(1 citation statement)

References 37 publications

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“…Limited reports of the subdural application of thrombolytic agents are available in the medical literature [ 2 , 5 - 8 ]. Based on previous publications that used local therapies with thrombolytic agents in cSDH, it was decided to use this approach to dissolve the subdural hematoma with r-tPA delivered via the catheter.…”

Section: Discussionmentioning

confidence: 99%

Burr Hole Hematoma Evacuation of Large Subdural Component Using Recombinant Tissue-Type Plasminogen Activator and a Novel Catheter: Case Report

Mônaco¹,

Krueger²,

Soldozy³

et al. 2022

Cureus

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The large acute component in a chronic subdural hematoma (cSDH) typically requires a craniotomy. Open surgery can be associated with increased morbidity and is not always possible due to systemic conditions. We present the case of a 58-year-old patient who presented with a Glasgow Coma Scale (GCS) of three fixed pupils, but remaining brainstem reflexes were present. Brain CT showed a large mixed subdural left chronic hematoma, with a predominant acute component, with a 26mm midline shift. The patient was hemodynamically unstable and coagulopathic; thus, emergency bedside burr hole evacuation was done. An “anti-thrombotic catheter” was left in the subdural space as a postoperative drain. Postoperatively, GCS improved, and CT presented a residual 12.7mm midline shift due to the acute bleeding component. Recombinant tissue-type plasminogen activator (r-tPA) solution was repeatedly administered using the catheter for two days, and it continued to drain for 10 more days with no additional dose. The patient presented clinical and radiological improvement with the dissolution of the acute component. This case is the first description of local subdural use of r-tPA to treat the acute component of cSDH with success associated with an anti-thrombotic catheter.

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Section: Discussionmentioning

confidence: 99%