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

• Kang HG
• Cho KY
• Lee RS
• Lim JS

• KMID: 2461114
• DOI: http://doi.org/10.13004/kjnt.2019.15.e32

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

Figure

• 

  FIGURE 1 A 38-year-old male patient was admitted with headache after a slip down. (A) At admission, a CT scan showed a hyperdense subdural hematoma (SDH) at right frontotemporoparietal lobe. (B) On the 7th day of admission, the hemiparesis and mild mental deterioration had been developed. The follow-up CT scan showed increase of a mixed density SDH and severe midline shifting. (C) A CT scan 6 days after trephination (after instillation of urokinase: 3 times for 3 days), representing marked decrease of the SDH and resolution of the mass effect. (D) A follow-up CT scan at postoperative 1 month showed no residual hemorrhage and mass effect.CT: computed tomography, SDH: subdural hematoma.

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