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Urokinase Is Safe and Effective in Reducing Recurrence in Chronic Subdural Hematoma After Burr-Hole Drainage
Eric Yuk Hong Cheung1, David Yuen Chung Chan1, Michael Wing Yan Lee1
1Department of Neurosurgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong Island, Hong Kong SAR; Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR.
Insights
Subdural urokinase significantly reduces chronic subdural hematoma (cSDH) recurrence after burr-hole drainage. This safe treatment lowers recurrence rates without increasing complications, offering a promising therapeutic option for cSDH management.
Area of Science:
- Neurosurgery
- Neurology
- Medical Research
Background:
- Chronic subdural hematoma (cSDH) poses a significant clinical challenge.
- Recurrence of cSDH after surgical drainage necessitates effective preventative strategies.
Purpose of the Study:
- To evaluate the safety and efficacy of subdural urokinase instillation in preventing cSDH recurrence.
- To identify factors associated with cSDH recurrence.
Main Methods:
- Retrospective analysis of 297 adult patients undergoing burr-hole drainage for cSDH.
- Comparison of recurrence rates and complication profiles between patients receiving subdural urokinase and those who did not.
- Statistical analyses including univariate and multivariate models.
Main Results:
- Symptomatic cSDH recurrence was significantly lower in the urokinase group (3.0%) compared to the no-urokinase group (11.7%).
- Urokinase instillation was an independent factor associated with reduced cSDH recurrence (OR=0.311, P=0.005).
- Complication rates (infection, hemorrhage) were similar between groups.
Conclusions:
- Subdural urokinase instillation is a safe and effective adjunctive therapy for reducing cSDH recurrence.
- Urokinase represents a valuable tool in the management of chronic subdural hematoma.
Objective:
This study aimed to evaluate the safety and efficacy of subdural urokinase in reducing the recurrence of chronic subdural hematoma (cSDH).
Methods:
Consecutive adults with cSDH and burr-hole drainage from 1 January 2013 to 31 December 2017 were retrospectively analyzed. Clinical records, radiologic images, laboratory data, and medication records were reviewed. The primary outcome was the recurrence rate of cSDH in patients with or without urokinase instillation. Secondary outcomes included complication rates such as infection and acute intracranial hemorrhage. Univariate and multivariate analyses were conducted to identify independent factors associated with cSDH recurrence.
Results:
A total of 297 consecutive patients were identified for analysis. The average dosage of urokinase instillation via the subdural drain into the subdural space was 15,800 units (5000-60,000 units) over a mean duration of 2 days (1-6 days). The symptomatic recurrence rate of cSDH was significantly lower with urokinase at 3.0% versus 11.7% with no urokinase (odds ratio: 0.234; P = 0.022). Univariate analysis and multivariate analysis showed that bilateral cSDH and the presence of underlying liver disease were significantly associated with higher recurrence, while the instillation of urokinase was significantly and independently associated with lower recurrence (odds ratio = 0.311; P = 0.005). Complication rates including infection and hemorrhage were comparable with patients with or without urokinase and had no significant difference.
Conclusions:
Instillation of urokinase was safe for patients with cSDH. The recurrence rate of cSDH was significantly lower with urokinase.
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