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A Novel Surgical Approach to Traumatic Intracranial Epidural Hematoma

DOI: 10.4236/oalib.1103820, PP. 1-12

Subject Areas: Surgery & Surgical Specialties, Neurology

Keywords: Urokinase, Single Burr Hole, Traumatic Epidural Hematoma, Hematoma Liquefaction

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Abstract

Objective: Traumatic intracranial epidural hematoma is considered to be the serious complication of head injury requiring appropriate evaluation and surgical intervention. Although craniotomy provides an effective evacuation of the hematoma, there is an insufficient data to support one particular surgical treatment method. The objective of this study is to address the effectiveness of Urokinase instillation via single burr hole in different time interval. Method: Forty two patients with traumatic epidural hematoma, ranging between 15 and 71 years who meet the inclusion criteria were selected for the retrospective study. All the patients were surgically treated in the First Affiliated Hospital of Liaoning Medical University from January 2013 to June 2015. Result: The common complication encountered in this study was headache, dizziness, fever and re-bleeding. In Group-A, 4 (19%) patients complained of headache, 5 (23.8%) dizziness, 1 (4.7%) fever and re-bleeding occurred in 2 (9.5%) patients. In Group-B, 2 (9.5%) patients complained of headache, 1 (4.7%) dizziness, 1 (4.7%) fever and 1 (4.7%) re-bleeding. Out of forty two patients, 3 (7.1%) patients encountered re-bleeding and received craniotomy. In this study, Group B demonstrates better outcome than Group A (P < 0.028). Conclusion: Single burr hole with Urokinase instillation is safe, feasible and effective technique in the treatment of traumatic epidural hematoma in selected cases where close regular clinical and radiological monitoring is possible.

Cite this paper

Shrestha, D. and Feng, L. (2017). A Novel Surgical Approach to Traumatic Intracranial Epidural Hematoma. Open Access Library Journal, 4, e3820. doi: http://dx.doi.org/10.4236/oalib.1103820.

References

[1]  Bullock, M.R., Chesnut, R., Ghajar, J., Gordon, D., Hartl, R., Newell, D.W., et al. (2006) Surgical Management of Acute Epidural Hematomas. Neurosurgery, 58, S7-S15.
[2]  Gupta, S.K., Tandon, S.C., Mohanty, S., Asthana, S. and Sharma, S. (1992) Bilateral Traumatic Extradural Hematomas: Report of 12 Cases with a Review of the Literature. Clinical Neurology and Neurosurgery, 94, 127-131.
[3]  Maggi, G., Aliberti, F., Petrone, G. and Ruggiero, C. (1998) Extradural Hematomas in Children. Journal of Neurosurgical Sciences, 42, 95-99.
[4]  Wu, J.J., Hsu, C.C., Liao, S.Y. and Wong, Y.K. (1999) Surgical Outcome of Traumatic Intracranial Hematoma at a Regional Hospital in Taiwan. The Journal of Trauma, 47, 39-43. https://doi.org/10.1097/00005373-199907000-00009
[5]  Winn, H.R. (2011) Youmans Neurological Surgery. Section XI-Trauma. 6th Edition, Elsevier, Amsterdam, 3267-3534.
[6]  Lee, E.J., Hung, Y.C., Wang, L.C., Chung, K.C. and Chen, H.H. (1998) Factors Influencing the Functional Outcome of Patients with Acute Epidural Hematomas: Analysis of 200 Patients Undergoing Surgery. The Journal of Trauma, 45, 946-952. https://doi.org/10.1097/00005373-199811000-00017
[7]  Hamilton, M. and Wallace, C. (1992) Nonoperative Manage-ment of Acute Epidural Hematoma Diagnosed by CT: The Neuroradiologist’s Role. American Journal of Neuroradiology, 13, 853-859.
[8]  Narayan, R.K., Narayan, T.M., Katz, D.A., Kornblith, P.L. and Murano, G. (1985) Lysis of Intracranial Hematomas with Urokinase in a Rabbit Model. Journal of Neurosurgery, 62, 580-586. https://doi.org/10.3171/jns.1985.62.4.0580
[9]  Servadei, F., Faccani, G., Roccella, P., Seracchioli, A., Godano, U., Ghadirpour, R., et al. (1989) Asymptomatic Extradural Hematomas. Results of Multicenter Study of 158 Cases in Minor Head Injury. Acta Neurochirurgica, 96, 39-45. https://doi.org/10.1007/BF01403493
[10]  Tallon, J.M., Ackroyd-Stolarz, S., Karim, S.A. and Clarke, D.B. (2008) The Epidemiology of Surgically Treated Acute Subdural and Epidural Hematomas in Patients with Head Injuries: A Population-Based Study. Canadian Journal of Surgery, 51, 339-345.
[11]  Chen, T.Y., Wong, C.W., Chang, C.N., Lui, T.N., Cheng, W.C., Tsai, M.D., et al. (1993) The Expectant Treatment of “Asymptomatic” Supratentorial Epidural Hematomas. Neurosurgery, 32, 176-179. https://doi.org/10.1227/00006123-199302000-00004
[12]  Bullock, R., Smith, R.M. and van Dellen, J.R. (1985) Nonoperative Management of Extradural Hematoma. Neurosurgery, 16, 602-606. https://doi.org/10.1227/00006123-198505000-00003
[13]  Liu, J.T., Tyan, Y.S., Lee, Y.K. and Wang, J.T. (2006) Emergency Management of Epidural Hematoma through Burr-Hole Evacuation and Drainage. A Preliminary Report. Acta Neurochirurgica, 148, 313-317. https://doi.org/10.1007/s00701-005-0723-z
[14]  Park, J., Kim, G.J. and Hwang, S.K. (2008) Thrombolytic Evacuation of Post-Craniotomy Epidural Hematomas Using Closed Suction Drains: A Pilot Study. Acta Neurochirurgica, 150, 359-366. https://doi.org/10.1007/s00701-007-1487-4
[15]  Doi, E., Moriwaki, H., Komai, N. and Iwamato, M. (1982) Stereotactic Evaluation of Intracerabral Hematomas. Neurologia Medico-Chirurgica, 22, 461-467. https://doi.org/10.2176/nmc.22.461
[16]  Findlay, J.M., Weir, B.K., Steinke, D., Tanabe, T., Gordon, P. and Grace, M. (1988) Effect of Intrathecal Thrombolytic Therapy on Subarachnoid Clot and Chronic Vasospasm in a Primate Model of SAH. Journal of Neurosurgery, 69, 723-735. https://doi.org/10.3171/jns.1988.69.5.0723
[17]  Mohadjer, M., Eggert, R., May, J. and Mayfrank, L. (1990) CT-Guided Stereotactic Fibrinolysis of Spontaneous and Hypertensive Cerebellar Hemorrhage: Long-Term Results. Journal of Neurosurgery, 73, 217-222. https://doi.org/10.3171/jns.1990.73.2.0217
[18]  Itabashi, H.H., Andrews, J.M., Tomiyasu, U., Erlich, S.S. and Sathyavagiswaran, L. (2007) Forensic Neuropathology: A Practical Review of the Fundamentals: Chapter 3-Dating/Aging of Common Lesions in Neuropathology. Elsevier, Amsterdam, 49-69.
[19]  Pang, D., Horton, J.A., Herron, J.M., Wilberger, J.E. and Vries, J.K. (1983) Nonsurgical Management of Extradural Hematomas in Children. Journal of Neurosurgery, 59, 958-971. https://doi.org/10.3171/jns.1983.59.6.0958
[20]  Kunamneni, A., Ravuri, B.D., Ellaiah, P., Prabhakhar, T. and Saisha, V. (2008) Urokinase—A Strong Plasminogen Activator. Biotechnology and Molecular Biology Reviews, 3, 58-70.
[21]  Bell, W.R. (1975) Thrombolytic Therapy. A Comparison between Urokinase and Streptokinase. Seminars in Thrombosis and Hemostasis, 2, 1-13. https://doi.org/10.1055/s-0028-1086111
[22]  Urokinase Pulmonary Embolism Trial Study Group (1974) Urokinase-Streptokinase Embolism Trial. JAMA, 229, 1606-1613. https://doi.org/10.1001/jama.1974.03230500024021
[23]  Pang, D., Sclabassi, R.J. and Horton, J.A. (1986) Lysis of Intraventricuar Blood Clot with Urokinase in a Canine Model: Part 3. Effective of Intraventricular Urokinase on Clot Lysis and Posthemorrhagic Hydrocephalus. Neurosurgery, 19, 553-572. https://doi.org/10.1227/00006123-198610000-00010
[24]  Jamieson, K.G. and Yelland, J.D. (1968) Extradural Hematoma. Report of 167 Cases. Journal of Neurosurgery, 29, 13-23. https://doi.org/10.3171/jns.1968.29.1.0013
[25]  Offner, P.J., Pham, B. and Hawkes, A. (2006) Nonoperative Management of Acute Epidural Hematomas: A “No-Brainer”. The American Journal of Surgery, 192, 801-805.
[26]  Bezircioglu, H., Ersahin, Y., Demircivi, F., Yurt, I., Donertas, K. and Tektas, S. (1996) Nonoperative Treatment of Acute Extradural Hematomas: Analysis of 80 Cases. Journal of Trauma, 41, 696-698. https://doi.org/10.1097/00005373-199610000-00016
[27]  Shah, M.V. (1999) Conservative Management of Epidural Hematomas: Is It Safe and Is It Cost-Effective? American Journal of Neuroradiology, 20, 115-116.
[28]  Pozzati, E. and Tognetti, F. (1986) Spontaneous Healing of Acute Extradural Hematomas: Study of Twenty-Two Cases. Neurosurgery, 18, 696-700. https://doi.org/10.1227/00006123-198606000-00003
[29]  Noguchi, M., Inamasu, J., Kawai, F., Kato, E., Kuramae, T., Oyanagi, T., et al. (2010) Ultrasound-Guided Needle Aspiration of Epidural Hematoma in a Neonate after Vacuum-Assisted Delivery. Child’s Nervous System, 26, 713-716. https://doi.org/10.1007/s00381-009-1072-7
[30]  Smets, K.J. and Vanhauwaert, D. (2010) Treatment of Cranial Epidural Hematoma in a Neonate by Needle Aspiration of a Communicating Cephalhematoma. European Journal of Pediatrics, 169, 617-619. https://doi.org/10.1007/s00431-009-1071-4
[31]  Liu, W., Ma, L., Wen, L., Shen, F., Sheng, H., Zhou, B., et al. (2008) Drilling Skull plus Injection of Urokinase in the Treatment of Epidural Hematoma: A Preliminary Study. Brain Injury, 22, 199-204. https://doi.org/10.1080/02699050801895407
[32]  Morgenstern, L.B., Demchuk, A.M., Kim, D.H., Frankowski, R.F. and Grotta, J.C. (2001) Rebleeding Leads to Poor Outcome in Ultra-Early Craniotomy for Intracerebral Hemorrhage. Neurology, 56, 1294-1299. https://doi.org/10.1212/WNL.56.10.1294
[33]  Lofgren, J. (1986) Traumatic Intracranial Hematomas. Pathophysiological Aspects on Their Course and Treatment. Acta Neurochirurgica Supplement, 36, 151-154.
[34]  Mclaurin, R.L. and Ford, L.E. (1964) Extradural Hematoma; Statistical Survey of Forty-Seven Cases. Journal of Neurosurgery, 21, 364-371. https://doi.org/10.3171/jns.1964.21.5.0364
[35]  Chang, G.Y., Woo, Y.J., Seong, H.K., Oh, L.K. and Min, S.K. (2016) The Effectiveness of Subdural Drains Using Urokinase after Burr Hole Evacuation of Subacute Subdural Hematoma in Elderly Patients: A Prelimilary Report. Korean Journal of Neurotrauma, 12, 101-106. https://doi.org/10.13004/kjnt.2016.12.2.101
[36]  Borovich, B., Braun, J., Guilburd, J.N., Zaaroor, M., Michich, M., Levy, L., et al. (1985) Delayed Onset of Traumatic Extradural Hematoma. Journal of Neurosurgery, 63, 30-34. https://doi.org/10.3171/jns.1985.63.1.0030

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