title: 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.
abstract: OBJECTIVE
  To evaluate whether increasing the volume drained from chronic subdural hematomas (SDHs) via either twist drill drainage (TDD) or burr hole drainage (BHD) followed by instillation of tissue plasminogen activator (tPA) is more efficacious than simple drainage alone.
  
  
  METHODS
  Patients admitted over the course of 42 months (2007-2010) to a single institution for treatment of chronic SDH were retrospectively evaluated.
  
  
  RESULTS
  There were 139 patients treated for chronic SDH; 54 patients were treated with BHD alone, 3 were treated with tPA after BHD, 85 were treated with TDD alone, and 12 were treated with tPA after TDD. Follow-up examinations were performed 1 month after treatment in 13 of 15 patients treated with tPA and 93 of 124 patients treated without tPA. Patients treated with tPA had a significantly lower rate of recurrence than patients treated without tPA (P=0.041). Patients treated with BHD had a recurrence rate of 11.8%, whereas patients treated with BHD and tPA had 0% recurrence. Patients treated with TDD had a recurrence rate of 30%, whereas patients treated with TDD and tPA had 0% recurrence. Without tPA, BHD was found to be a significantly better treatment than TDD (P=0.016). Mean drainage for TDD with tPA was 427.33 mL. There were no complications related to the administration of tPA.
  
  
  CONCLUSIONS
  This study adds another therapeutic option for patients with chronic SDH requiring treatment. In this retrospective study, the addition of tPA increased the volume of hematoma drained and significantly reduced the incidence of recurrence requiring further intervention regardless of cranial access route. No complications occurred related directly or indirectly to the administration of tPA. Further study of this technique is warranted.
authors: Illinois Neurological Institute, Department of Neurosurgery, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA. dmneils@yahoo.com
authors: David M
authors: DM
authors: Neils
authors: Pradeep S
authors: PS
authors: Singanallur
authors: Huaping
authors: H
authors: Wang
authors: Patrick
authors: P
authors: Tracy
authors: Jeffrey
authors: J
authors: Klopfenstein
authors: Dzung
authors: D
authors: Dinh
authors: Patrick W
authors: PW
authors: Elwood
authors: Daniel
authors: D
authors: Fassett
authors: Todd
authors: T
authors: McCall
authors: Julian
authors: J
authors: Lin
authors: Andrew
authors: A
authors: Tsung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D020200:Hematoma, Subdural, Chronic / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007322:Instillation, Drug; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D055502:Secondary Prevention; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D014207:Trephining
chemical_list: D010959:Tissue Plasminogen Activator