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Management of acute subdural hematomas in infants: intrathecal infusion streptokinase for clot lysis combined with subdural to subgaleal shunt

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Abstract

Object

Subdural hematomas (SDHs) in full-term infants have the potential to cause death or lifelong disability. We report management and outcomes of eight cases of newborn with large SDH treated by streptokinase (SK) lavage and drainage.

Materials and methods

Between 2003 and 2006, eight infants with large acute SDH with focal or diffuse hypodensity showing signs and symptoms of neurological deterioration were treated by drainage and subdural SK lavage. There were eight full-term infants, five boys and three girls, with ages between 10 days and 2 months. Head injuries were shaken baby syndrome in three cases, fall from height in three cases, caused by traffic accident in one case, and reportedly not due to trauma in one case. In all patients, SDHs were unilateral. We used a new surgical approach, SDH evacuation, involving the subdural instillation of SK for lysis and after drainage of acute SDH in infants. Follow-up in the series ranged from 1 to 42 months (average 30 months). There was no mortality in this series, neither in the early postoperative period nor in the follow-up period. Five patients of this series lead a normal life; two children were mildly neurodevelopmentally delayed.

Conclusion

Subdural infusion of SK followed by drainage may be as safe and effective for treatment of acute SDHs in infants as other reported methods.

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Acknowledgments

We greatly appreciate Prof. David B. Shurtleff, Department of Pediatrics, University of Washington and Ali Guermazi, MD, Department of Radiology, Boston University Medical Center for their support and criticism in the writing of this article.

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Authors and Affiliations

  1. Department of Neurosurgery, Irkutsk Medical University, Irkutsk, Russia

    Sergey N. Larionov

  2. Department Neurosurgery of Scientific Center of Reconstructive and Restorative Surgery of Eastern-Siberian Scientific Center Siberian Branch of Russian Academy of Medical Sciences, Irkutsk, Russia

    Vladimir A. Sorokovikov

  3. Department of Neonatal Surgery, «Children’s Hospital», Irkutsk, Russia

    Vladimir A. Novozilov

  4. Department of Neurosurgery, Irkutsk Regional Children’s Hospital, Gagarina 4, Irkutsk, 664022, Russia

    Sergey N. Larionov

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  1. Sergey N. Larionov
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  2. Vladimir A. Sorokovikov
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  3. Vladimir A. Novozilov
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Correspondence to Sergey N. Larionov.

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Larionov, S.N., Sorokovikov, V.A. & Novozilov, V.A. Management of acute subdural hematomas in infants: intrathecal infusion streptokinase for clot lysis combined with subdural to subgaleal shunt. Childs Nerv Syst 24, 437–442 (2008). https://doi.org/10.1007/s00381-007-0496-1

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  • DOI: https://doi.org/10.1007/s00381-007-0496-1

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