Local Fibrinolysis of Traumatic Epi- and Subdural Hematomas

Pryanichnikov A.V.*, Makarov V.E.*, Kiselev A.V.**, Pyankov A.V.***

* Central City Clinical Hospital, Yekaterinburg, Russia
** Ural State Medical Academy, Yekaterinburg, Russia
*** Sverdlovsk Regional Centre of Medicine of Catastrophes, Yekaterinburg, Russia

 

The study goal has been comparing efficacy of craniostomy and closed external drainage with subsequent fibrinolysis with streptokinase, used for treatment of cases with various traumatic epi- and subdural hematomas.

Material and Methods. A number of examined and operated cases was 42. They were divided into three groups, depending on a hematoma volume. Small, median and large hematomas were watched in 23 (54.8%), 17 (40.5%) and 2 (4.8%), respectively. Operations were performed on the 1st - 18th day after trauma.

Results and Discussion. Fibrinolysis duration was as follows: 24 hours (26 cases with small acute and subacute epi- and subdural hematomas and 11 cases with median subacute subdural hematomas), 48 hours (2 cases with large acute subdural and epidural hematomas), 72 hours (3 cases with median acute subdural and epidural hematomas). Clinical manifestation of acute and subacute subdural hematomas regressed during 24 hours. As for acute and subacute epidural hematomas, it took 15 days. In case of a favorable outcome a period of stay in hospital was 26±8.6 days. The patients were discharged in a satisfactory state and without neurological deficit. There were 7 fatal outcomes (16.7%): 5 cases died of severe extracranial pathology during 3-15 days, 1 of persistent bleeding and dislocation syndrome on the third day and 1 of meningitis and ventriculitis on the 38th day.

Conclusion. Local fibrinolysis can be an effective means of removal of traumatic epi- and subdural hematomas in compensated and subcompensated cases. Hematoma localization, its volume and age have no impact on outcome.