The Effectiveness of Subdural Drains Using Urokinase after Burr Hole Evacuation of Subacute Subdural Hematoma in Elderly Patients: A Prelimilary Report

Abstract

ObjectiveA subdural drain using urokinase after a burr hole hematoma evacuation was performed for subacute subdural hematoma (SASDH), and its effectiveness and safety in elderly patients were evaluated.MethodsBetween January 2013 and May 2015, subdural drains using urokinase after burr hole hematoma evacuation were performed in 19 elderly patients. The inclusion criteria were as follows: 1) a subdural hematoma occurring between 4 and 20 days after injury; 2) worsening neurological symptoms, from mild to moderate or severe, due to injury during the subacute stage; 3) a mix of solid clots (high-density lighter shadow) and fluid hematoma (low-density darker shadow) on the computed tomography (CT) scan; 4) a score of ≥9 on the Glasgow Coma Scale (GCS) assessed immediately before surgery; and 5) an age of ≥65 years. When the majority of the hematoma was evacuated on the CT, we removed the catheter.ResultsUnder local anesthesia, a catheter was inserted into the hematoma through a burr hole. The mean age of the patients was 73.7 years (range, 65-87 years). The mean preoperative GCS score was 11.2 (range, 10-13), and the mean Glasgow Outcome Scale score for all patients was 5 at discharge. No recurrences of hematomas or surgical complications were observed.ConclusionA subdural drain using urokinase after burr hole hematoma evacuation under local anesthesia is thought to be an effective and safe method of blood clot removal with low morbidity. This surgical method is less invasive for treating elderly patients with SASDH.

Case report: Ultrasound-guided percutaneous drainage combined with lavage using urokinase: An economical and effective treatment for muscular hematomas in hemophiliacs

“…Ultrasoundguided percutaneous drainage is an immediate, low-cost, minimally invasive method for the treatment of muscular hematoma in hemophiliacs, but its effectiveness is questionable when muscular hematomas resulting from repeated bleeding are too viscous for effective draining (2-4). Urokinase that degrades fibrin in blood clots dissolves the viscous contents of hematomas by intracavitary lavage such as intracranial, subdural, and retroperitoneal lavages (5)(6)(7). Therefore, we firstly attempted to perform ultrasound-guided drainage combined with lavage using urokinase to treat large muscular hematomas in hemophilia cases.…”

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

“…Trephine drainage using UK is usually performed as safe method to reduce the intracranial pressure or remove hematoma by draining cerebrospinal fluid or hematoma in spontaneous acute intraventricular or intracerebral hemorrhage 351321). We think that UK instillation after trephine hematoma drainage can be a good minimal invasive treatment method for the patients with good GCS score regardless of age, the patients who had a risk of bleeding due to antithrombotic medication, and it may be more helpful for aged decrepit patients.…”

Evaluation of cortical brain parenchyma, by diffusion and perfusion mri, before and after chronic subdural hematoma surgery

“…The causative factors for SDHs include previous trauma, coagulopathies, intracranial hypotension, chronic alcoholism, vascular malformations, and intracranial masses (1). According to the time of development, SDHs that develop within the first 3 days are classified as acute SDHs, those that develop within 4-20 days are classified as sub-acute SDHs, and those that develop after 21 days are classified as chronic SDHs (CSDHs) (14). CSDHs reflect the organization of the █ INTRODUCTION I ntracranial subdural hematomas (SDHs) are hemorrhages that develop between the dura mater and the arachnoid mater and are likely to be associated with high mortality and morbidity.…”