Background: Current literature provides little
consensus on 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). The study aims to explore the efficacy of TDD with and
without tPA, at achieving clinically relevant drainage (200mL) and reducing
recurrence of cSDH. 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 control group (n=17), TDD without tPA. Variables of interest
include initial hematoma volume, volume drained, length of stay, and
recurrence rates. Descriptive analysis was run.
Results: Average age for patients was 74.6 with
76% male. Mean drainage volumes for the tPA cohort was 381.6mL and TDD
without tPA cohort was 151.3mL. The addition of tPA resulted in drainage
volumes nearly double (1.9x) the clinically relevant amount and had low
recurrence rates (12.5%). TDD without tPA failed to result in clinically
relevant drainage and had a recurrence rate of 52.9%. Average length of stay
differed by two days (9.71 tPA; 7.71 control).
Conclusions: TDD with tPA was effective at
treating cSDH in our population.
P.206 Tissue Plasminogen Activator in Addition to Twist Drill Drainage as
a Treatment for Chronic Subdural Hematomas – A Descriptive Analysis
