Drilling skull plus injection of urokinase in the treatment of epidural haematoma: a preliminary study.

PRIMARY OBJECTIVE: This study was performed to evaluate the effectiveness of a minimally invasive approach to manage patients with epidural haematoma (EDH). The surgical indication and key points were investigated.

RESEARCH DESIGN: Descriptive, retrospective study.

METHODS AND PROCEDURES: Twenty-one patients with traumatic EDH were treated through the following method: After anaesthesia, twist drill trepanations were performed followed by a placement of drainage tubes. Twenty ku urokinase in 3 ml saline was injected into the haematoma cyst through the tube, which was closed for 3 hours before connection to a vacuum ball with negative pressure. The injection was repeated three times a day after operation. The fibrinolytic agents were not used in the 'acute group' because of the risk of rebleeding. CT scans were performed according to the changes of clinical manifestations.

MAIN OUTCOMES AND RESULTS: The drainage tubes were left for 3-5 days before most clots were resolved. The patients discharged after 7 days' hospitalization on average. No infections or recurrence of EDHs were observed in this series.

CONCLUSION: Drilling skull plus injection of urokinase through drainage tube is a safe and effective method with less injury in the treatment of a selected part of patients with EDHs.