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

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Last updated: 27 Dec 2024

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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.

DOI

10.21608/pajn.2021.86982.1031

Keywords

chronic subdural hematoma, tissue plasminogen activator, twist drill drainage

Authors

First Name

Alyssa

Last Name

Dickinson

MiddleName

-

Affiliation

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

Email

alyssa.dickinson@dal.ca

City

Saint John

Orcid

-

First Name

Andre

Last Name

leRoux

MiddleName

-

Affiliation

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

Email

andries.leroux@horizonnb.ca

City

-

Orcid

-

First Name

George

Last Name

Kolyvas

MiddleName

-

Affiliation

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

Email

george.kolyvas@horizonnb.ca

City

-

Orcid

-

First Name

Dana

Last Name

El-Mughayyar

MiddleName

-

Affiliation

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

Email

dana.el-mughayyar@horizonnb.ca

City

-

Orcid

0000-0003-0074-1194

First Name

Nora

Last Name

Ghallab

MiddleName

-

Affiliation

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

Email

dr.noraghallab@outlook.com

City

-

Orcid

-

First Name

Erin

Last Name

Bigney

MiddleName

-

Affiliation

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

Email

cescresearch@gmail.com

City

-

Orcid

-

First Name

Eden

Last Name

Richardson

MiddleName

-

Affiliation

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

Email

eden.richardson@horizonnb.ca

City

-

Orcid

-

First Name

Amanda

Last Name

Vandewint

MiddleName

-

Affiliation

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

Email

amanda.vandewint@horizonnb.ca

City

-

Orcid

-

First Name

Najmedden

Last Name

Attabib

MiddleName

-

Affiliation

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

Email

attabib2002@yahoo.com

City

Saint John

Orcid

-

Volume

17

Article Issue

1

Related Issue

35182

Issue Date

2022-06-01

Receive Date

2021-07-28

Publish Date

2022-06-01

Page Start

25

Page End

30

Print ISSN

1319-6995

Online ISSN

2735-4482

Article File

PAJN_Volume 17_Issue 1_Pages 25-30.pdf

PDF . 564.3kB

Link

https://pajn.journals.ekb.eg/article_245500.html

Detail API

https://pajn.journals.ekb.eg/service?article_code=245500

Order

5

Type

Original Articles

Type Code

1,544

Publication Type

Journal

Publication Title

Pan Arab Journal of Neurosurgery

Publication Link

https://pajn.journals.ekb.eg/

MainTitle

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

Details

Type

Article

Created At

23 Jan 2023