Recurrence-Free Chronic Subdural Hematomas: A Retrospective Analysis of the Instillation of Tissue Plasminogen Activator in Addition to Twist Drill or Burr Hole Drainage in the Treatment of Chronic Subdural Hematomas

Neils, David M.; Singanallur, Pradeep S.; Wang, Huaping; Tracy, Patrick T.; Klopfenstein, Jeffrey D.; Dinh, Dzung H.; Elwood, Patrick W.; Fassett, Daniel R.; McCall, Todd D.; Lin, Julian; Tsung, Andrew J.

doi:10.1016/j.wneu.2011.08.032

Cited by 30 publications

(31 citation statements)

References 15 publications

(23 reference statements)

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“…Of interest in the rough outcome summary is that proportionately, craniotomies resulted in the most deaths, burr holes resulted in the most nonfatal complications, and twist drills had the most recurrence with the least proportion cured 59 . The increased recurrence of hematomas with twist drills is noticed in several other studies 10,52,55,66 .…”

Section: Pharmacologic Supplementation To Surgerysupporting

confidence: 53%

“…A 2007-2010 study of 139 patients infused 1 mg/mL tPA into drained burr hole and twist drill patients post-operation as needed if the patient became symptomatic and the drainage was <50mL. This protocol addition significantly reduced the recurrence rate to 0% for both treatments, though the sample sizes were low for the experimental group 66 .…”

Section: Pharmacologic Supplementation To Surgerymentioning

confidence: 99%

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Evolving management of symptomatic chronic subdural hematoma: experience of a single institution and review of the literature

Balser

Rodgers

Johnson

et al. 2013

Neurological Research

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Objective-Chronic subdural hematoma has an increasing incidence and results in high morbidity and mortality. We review here the ten-year experience of a single institution and the literature regarding the treatment and major associations of chronic subdural hematoma (cSDH).Methods-We retrospectively reviewed all cSDHs surgically treated from 2000 to 2010 at our institution to evaluate duration from admission to treatment, type of treatment, length of stay in critical care, length of stay in the hospital and recurrence. The literature was reviewed with regards to incidence, associations and treatment of cSDH. [2000][2001][2002][2003][2004][2005][2006][2007][2008]44 patients were treated with burr holes. From 2008 to 2010, 29 patients were treated with twist drill evacuation (SEPS). 4 patients from each group were readmitted for reoperation (9% vs. 14%; p=.53). The average time to intervention for SEPS (11.2±15.3 hrs) was faster than for burr holes (40.3±69.1 hrs) (p=.02). The total hospital LOS was shorter for SEPS (9.3±6.8 days) versus burr holes (13.4±10.2 days) (p=.04); both were significantly longer than for a brain tumor patient undergoing craniotomy (7.0±0.5 days, n=94, P<. 01). Results-FromConclusion-Despite decreasing lengths of stay over time as treatment for cSDH evolved from burr holes to SEPS, the length of stay for a cSDH is still greater than that of a patient undergoing craniotomy for brain tumor. We noted 11% recurrence in our series of patients, which included individuals who recurred as late as 3 years after initial diagnosis.

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Section: Pharmacologic Supplementation To Surgerysupporting

confidence: 53%

Section: Pharmacologic Supplementation To Surgerymentioning

confidence: 99%

Evolving management of symptomatic chronic subdural hematoma: experience of a single institution and review of the literature

Balser

Rodgers

Johnson

et al. 2013

Neurological Research

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“…The recurrence rate (0.43%, 95% CI 0-1.29%) was relatively low compared with previous reports. Our results were consistent with a previous report by Singanallur and colleagues [27]. They instilled tissue plasminogen activator (t-PA) into the hematoma cavity after TDC or BHC for CSDH treatment, resulting in zero recurrence, although the sample size was small and only 15 patients were included.…”

Section: Advantage Of Urokinase Instillationsupporting

confidence: 91%

An improved electronic twist-drill craniostomy procedure with post-operative urokinase instillation in treating chronic subdural hematoma

Shen

et al. 2015

Clinical Neurology and Neurosurgery

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“…However, the differences were not statistically significant. Nevertheless, recurrence rates of up to 33% after burr hole trephination and 30% after percutaneous twist drill drainage have been described [19,23]. These data stress the need to optimize the initial treatment algorithms.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for reoperation after initial burr hole trephination in chronic subdural hematomas

Schwarz

Loos

Dünisch

et al. 2015

Clinical Neurology and Neurosurgery

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Recurrence-Free Chronic Subdural Hematomas: A Retrospective Analysis of the Instillation of Tissue Plasminogen Activator in Addition to Twist Drill or Burr Hole Drainage in the Treatment of Chronic Subdural Hematomas

Cited by 30 publications

References 15 publications

Evolving management of symptomatic chronic subdural hematoma: experience of a single institution and review of the literature

Evolving management of symptomatic chronic subdural hematoma: experience of a single institution and review of the literature

An improved electronic twist-drill craniostomy procedure with post-operative urokinase instillation in treating chronic subdural hematoma

Risk factors for reoperation after initial burr hole trephination in chronic subdural hematomas

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