Loading…
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
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 admitte...
Saved in:
Published in: | World neurosurgery 2012-07, Vol.78 (1), p.145-149 |
---|---|
Main Authors: | , , , , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
cited_by | cdi_FETCH-LOGICAL-c411t-a75822c6e95aefe450b8a64768277eb0f05267de7d5976cadb48a598f7e6a5873 |
---|---|
cites | cdi_FETCH-LOGICAL-c411t-a75822c6e95aefe450b8a64768277eb0f05267de7d5976cadb48a598f7e6a5873 |
container_end_page | 149 |
container_issue | 1 |
container_start_page | 145 |
container_title | World neurosurgery |
container_volume | 78 |
creator | Neils, David M Singanallur, Pradeep S Wang, Huaping Tracy, Patrick Klopfenstein, Jeffrey Dinh, Dzung Elwood, Patrick W Fassett, Daniel McCall, Todd Lin, Julian Tsung, Andrew |
description | 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. |
doi_str_mv | 10.1016/j.wneu.2011.08.032 |
format | article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1033454800</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1878875011010631</els_id><sourcerecordid>1033454800</sourcerecordid><originalsourceid>FETCH-LOGICAL-c411t-a75822c6e95aefe450b8a64768277eb0f05267de7d5976cadb48a598f7e6a5873</originalsourceid><addsrcrecordid>eNp9Ul1vFCEUnRiNbdb-AR8Mj77sCMwHrDEm62rdJk007fpMWOZOyzoDKzBt9p_6c7y4tQ8mygtwOefAPYeieMloyShr3-zKewdTySljJZUlrfiT4pRJIedStIunj-uGnhRnMe4ojorVUlTPixPOGad8UZ8WP6_ATCGAMzA_DwBkdRu8s4ZcT9tuCnogaxh18qOOb8mSXEEKPu7BJHsHZOn0cIg2Et-TdAvkwsVkh0En612ubWyME5Cvg46jdf4GHFlmJuoFYnHTdfY3NnmyubcxkY8B-QRPP-CjyNoPgCVtnb6BTMiXbALoNIJL-YZ_v_ZF8azXQ4Szh3lWfDv_tFmt55dfPl-slpdzUzOW5lo0knPTwqLR0EPd0K3UbS1ayYWALe1pw1vRgeiahWiN7ra11M1C9gJa3aCbs-L1UXcf_I8JYlKjjQbQBQd-iorRqqqbWqL7s4IfoQY9jAF6tQ921OGAIJVDVTuVQ1U5VEWlwlCR9OpBf9qO0D1S_kSIgHdHAGCXdxaCisbmPDsbMCfVeft__fd_0c1g0VI9fIcDxJ2fAqaMfajIFVXX-VvlX8VQkLYVq34BK3_LzA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1033454800</pqid></control><display><type>article</type><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</title><source>ScienceDirect Freedom Collection</source><creator>Neils, David M ; Singanallur, Pradeep S ; Wang, Huaping ; Tracy, Patrick ; Klopfenstein, Jeffrey ; Dinh, Dzung ; Elwood, Patrick W ; Fassett, Daniel ; McCall, Todd ; Lin, Julian ; Tsung, Andrew</creator><creatorcontrib>Neils, David M ; Singanallur, Pradeep S ; Wang, Huaping ; Tracy, Patrick ; Klopfenstein, Jeffrey ; Dinh, Dzung ; Elwood, Patrick W ; Fassett, Daniel ; McCall, Todd ; Lin, Julian ; Tsung, Andrew</creatorcontrib><description>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.</description><identifier>ISSN: 1878-8750</identifier><identifier>EISSN: 1878-8769</identifier><identifier>DOI: 10.1016/j.wneu.2011.08.032</identifier><identifier>PMID: 22120294</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Burr hole drainage ; Combined Modality Therapy ; Hematoma, Subdural, Chronic - diagnosis ; Hematoma, Subdural, Chronic - therapy ; Humans ; Instillation, Drug ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neurosurgery ; Postoperative Complications - diagnosis ; Postoperative Complications - surgery ; Reoperation ; Retrospective Studies ; Secondary Prevention ; Subdural hematoma ; Tissue Plasminogen Activator - administration & dosage ; Tomography, X-Ray Computed ; Trephining ; Twist drill drainage</subject><ispartof>World neurosurgery, 2012-07, Vol.78 (1), p.145-149</ispartof><rights>Elsevier Inc.</rights><rights>2012 Elsevier Inc.</rights><rights>Copyright © 2012 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-a75822c6e95aefe450b8a64768277eb0f05267de7d5976cadb48a598f7e6a5873</citedby><cites>FETCH-LOGICAL-c411t-a75822c6e95aefe450b8a64768277eb0f05267de7d5976cadb48a598f7e6a5873</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22120294$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Neils, David M</creatorcontrib><creatorcontrib>Singanallur, Pradeep S</creatorcontrib><creatorcontrib>Wang, Huaping</creatorcontrib><creatorcontrib>Tracy, Patrick</creatorcontrib><creatorcontrib>Klopfenstein, Jeffrey</creatorcontrib><creatorcontrib>Dinh, Dzung</creatorcontrib><creatorcontrib>Elwood, Patrick W</creatorcontrib><creatorcontrib>Fassett, Daniel</creatorcontrib><creatorcontrib>McCall, Todd</creatorcontrib><creatorcontrib>Lin, Julian</creatorcontrib><creatorcontrib>Tsung, Andrew</creatorcontrib><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</title><title>World neurosurgery</title><addtitle>World Neurosurg</addtitle><description>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.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Burr hole drainage</subject><subject>Combined Modality Therapy</subject><subject>Hematoma, Subdural, Chronic - diagnosis</subject><subject>Hematoma, Subdural, Chronic - therapy</subject><subject>Humans</subject><subject>Instillation, Drug</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neurosurgery</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - surgery</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Secondary Prevention</subject><subject>Subdural hematoma</subject><subject>Tissue Plasminogen Activator - administration & dosage</subject><subject>Tomography, X-Ray Computed</subject><subject>Trephining</subject><subject>Twist drill drainage</subject><issn>1878-8750</issn><issn>1878-8769</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><recordid>eNp9Ul1vFCEUnRiNbdb-AR8Mj77sCMwHrDEm62rdJk007fpMWOZOyzoDKzBt9p_6c7y4tQ8mygtwOefAPYeieMloyShr3-zKewdTySljJZUlrfiT4pRJIedStIunj-uGnhRnMe4ojorVUlTPixPOGad8UZ8WP6_ATCGAMzA_DwBkdRu8s4ZcT9tuCnogaxh18qOOb8mSXEEKPu7BJHsHZOn0cIg2Et-TdAvkwsVkh0En612ubWyME5Cvg46jdf4GHFlmJuoFYnHTdfY3NnmyubcxkY8B-QRPP-CjyNoPgCVtnb6BTMiXbALoNIJL-YZ_v_ZF8azXQ4Szh3lWfDv_tFmt55dfPl-slpdzUzOW5lo0knPTwqLR0EPd0K3UbS1ayYWALe1pw1vRgeiahWiN7ra11M1C9gJa3aCbs-L1UXcf_I8JYlKjjQbQBQd-iorRqqqbWqL7s4IfoQY9jAF6tQ921OGAIJVDVTuVQ1U5VEWlwlCR9OpBf9qO0D1S_kSIgHdHAGCXdxaCisbmPDsbMCfVeft__fd_0c1g0VI9fIcDxJ2fAqaMfajIFVXX-VvlX8VQkLYVq34BK3_LzA</recordid><startdate>20120701</startdate><enddate>20120701</enddate><creator>Neils, David M</creator><creator>Singanallur, Pradeep S</creator><creator>Wang, Huaping</creator><creator>Tracy, Patrick</creator><creator>Klopfenstein, Jeffrey</creator><creator>Dinh, Dzung</creator><creator>Elwood, Patrick W</creator><creator>Fassett, Daniel</creator><creator>McCall, Todd</creator><creator>Lin, Julian</creator><creator>Tsung, Andrew</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120701</creationdate><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</title><author>Neils, David M ; Singanallur, Pradeep S ; Wang, Huaping ; Tracy, Patrick ; Klopfenstein, Jeffrey ; Dinh, Dzung ; Elwood, Patrick W ; Fassett, Daniel ; McCall, Todd ; Lin, Julian ; Tsung, Andrew</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-a75822c6e95aefe450b8a64768277eb0f05267de7d5976cadb48a598f7e6a5873</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Burr hole drainage</topic><topic>Combined Modality Therapy</topic><topic>Hematoma, Subdural, Chronic - diagnosis</topic><topic>Hematoma, Subdural, Chronic - therapy</topic><topic>Humans</topic><topic>Instillation, Drug</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neurosurgery</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - surgery</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Secondary Prevention</topic><topic>Subdural hematoma</topic><topic>Tissue Plasminogen Activator - administration & dosage</topic><topic>Tomography, X-Ray Computed</topic><topic>Trephining</topic><topic>Twist drill drainage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Neils, David M</creatorcontrib><creatorcontrib>Singanallur, Pradeep S</creatorcontrib><creatorcontrib>Wang, Huaping</creatorcontrib><creatorcontrib>Tracy, Patrick</creatorcontrib><creatorcontrib>Klopfenstein, Jeffrey</creatorcontrib><creatorcontrib>Dinh, Dzung</creatorcontrib><creatorcontrib>Elwood, Patrick W</creatorcontrib><creatorcontrib>Fassett, Daniel</creatorcontrib><creatorcontrib>McCall, Todd</creatorcontrib><creatorcontrib>Lin, Julian</creatorcontrib><creatorcontrib>Tsung, Andrew</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>World neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Neils, David M</au><au>Singanallur, Pradeep S</au><au>Wang, Huaping</au><au>Tracy, Patrick</au><au>Klopfenstein, Jeffrey</au><au>Dinh, Dzung</au><au>Elwood, Patrick W</au><au>Fassett, Daniel</au><au>McCall, Todd</au><au>Lin, Julian</au><au>Tsung, Andrew</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>World neurosurgery</jtitle><addtitle>World Neurosurg</addtitle><date>2012-07-01</date><risdate>2012</risdate><volume>78</volume><issue>1</issue><spage>145</spage><epage>149</epage><pages>145-149</pages><issn>1878-8750</issn><eissn>1878-8769</eissn><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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>22120294</pmid><doi>10.1016/j.wneu.2011.08.032</doi><tpages>5</tpages></addata></record> |
fulltext | fulltext |
identifier | ISSN: 1878-8750 |
ispartof | World neurosurgery, 2012-07, Vol.78 (1), p.145-149 |
issn | 1878-8750 1878-8769 |
language | eng |
recordid | cdi_proquest_miscellaneous_1033454800 |
source | ScienceDirect Freedom Collection |
subjects | Aged Aged, 80 and over Burr hole drainage Combined Modality Therapy Hematoma, Subdural, Chronic - diagnosis Hematoma, Subdural, Chronic - therapy Humans Instillation, Drug Magnetic Resonance Imaging Male Middle Aged Neurosurgery Postoperative Complications - diagnosis Postoperative Complications - surgery Reoperation Retrospective Studies Secondary Prevention Subdural hematoma Tissue Plasminogen Activator - administration & dosage Tomography, X-Ray Computed Trephining Twist drill drainage |
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 |
url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T17%3A54%3A13IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Recurrence-Free%20Chronic%20Subdural%20Hematomas:%20A%20Retrospective%20Analysis%20of%20the%20Instillation%20of%20Tissue%20Plasminogen%20Activator%20in%20Addition%20to%20Twist%20Drill%20or%20Burr%20Hole%20Drainage%20in%20the%20Treatment%20of%20Chronic%20Subdural%20Hematomas&rft.jtitle=World%20neurosurgery&rft.au=Neils,%20David%20M&rft.date=2012-07-01&rft.volume=78&rft.issue=1&rft.spage=145&rft.epage=149&rft.pages=145-149&rft.issn=1878-8750&rft.eissn=1878-8769&rft_id=info:doi/10.1016/j.wneu.2011.08.032&rft_dat=%3Cproquest_cross%3E1033454800%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c411t-a75822c6e95aefe450b8a64768277eb0f05267de7d5976cadb48a598f7e6a5873%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1033454800&rft_id=info:pmid/22120294&rfr_iscdi=true |