• Eric Yuk Hong Cheung, ChanDavid Yuen ChungDYCDepartment of Neurosurgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong Island, Hong Kong SAR; Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR. Electronic address: da, LeeMichael Wing YanMWYDepartment of Neurosurgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong Island, Hong Kong SAR; Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR., Cheung Yu Hung, and Kai Yuen Pang.
• Department of Neurosurgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong Island, Hong Kong SAR; Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR.
• World Neurosurg. 2022 Aug 1; 164: e1209-e1213.

ObjectiveThis study aimed to evaluate the safety and efficacy of subdural urokinase in reducing the recurrence of chronic subdural hematoma (cSDH).MethodsConsecutive adults with cSDH and burr-hole drainage from 1 January 2013 to 31 December 2017 were retrospectively analyzed. Clinical records, radiologic images, laboratory data, and medication records were reviewed. The primary outcome was the recurrence rate of cSDH in patients with or without urokinase instillation. Secondary outcomes included complication rates such as infection and acute intracranial hemorrhage. Univariate and multivariate analyses were conducted to identify independent factors associated with cSDH recurrence.ResultsA total of 297 consecutive patients were identified for analysis. The average dosage of urokinase instillation via the subdural drain into the subdural space was 15,800 units (5000-60,000 units) over a mean duration of 2 days (1-6 days). The symptomatic recurrence rate of cSDH was significantly lower with urokinase at 3.0% versus 11.7% with no urokinase (odds ratio: 0.234; P = 0.022). Univariate analysis and multivariate analysis showed that bilateral cSDH and the presence of underlying liver disease were significantly associated with higher recurrence, while the instillation of urokinase was significantly and independently associated with lower recurrence (odds ratio = 0.311; P = 0.005). Complication rates including infection and hemorrhage were comparable with patients with or without urokinase and had no significant difference.ConclusionsInstillation of urokinase was safe for patients with cSDH. The recurrence rate of cSDH was significantly lower with urokinase.Copyright © 2022 Elsevier Inc. All rights reserved.

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