Tissue Plasminogen Activator in Addition to Twist Drill Drainage as a Treatment for Chronic Subdural Hematomas – A Descriptive Analysis

Document Type : Original Articles

Authors

1 Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada

2 Department of Neurosurgery, Horizon Health Network, Saint John, New Brunswick, Canada; Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada; Canada East Spine Centre, Saint John, New Brunswick, Canada

3 Canada East Spine Centre, Saint John, New Brunswick, Canada; University of New Brunswick, Fredericton, New Brunswick, Canada

4 Canada East Spine Centre, Saint John, New Brunswick, Canada

5 Canada East Spine Centre, Saint John, New Brunswick, Canada; Horizon Health Network, Saint John, New Brunswick, Canada

6 Canada East Spine Centre, Saint John, New Brunswick, Canada; Horizon Health Network, Saint John, New Brunswick, Canada; Canadian Spine Society, Markham, Ontario, Canada

Abstract

Background: Current literature lacks robust universal guidelines for first-line treatment of chronic subdural hematomas (cSDH). However, administration of local tissue plasminogen activator (tPA) may enhance the traditional method of twist drill drainage (TDD).

Purpose: The study aims to explore the efficacy of TDD with and without tPA, at achieving clinically relevant drainage (200mL) and reducing recurrence of cSDH.

Patients and Methods: A retrospective review of patients (N=34) with cSDH is presented. Patients who received TDD with tPA (n=17) were identified and matched, based primarily on age and hematoma volume, to a TDD only group (n=17). Variables of interest include hematoma volume, volume drained, length of stay, and recurrence rates. Descriptive analysis was run.

Results: Average age for patients (N=34) was 73.9 years. The majority of the cohort (76%) was male. Mean drainage volume for the tPA cohort was 381.6mL and TDD only cohort was 187.8mL. The addition of tPA resulted in drainage volumes nearly double (1.9x) the clinically relevant amount and had low recurrence rates (6.3%). TDD only failed to result in clinically relevant drainage and had a recurrence rate of 37.5%. Average length of stay in neurosurgical hospital care was 9.71 days for the tPA group, and 7.65 days for TDD only.

Conclusion: TDD with tPA was effective at treating cSDH in our population.

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