Use of topically applied rt-PA in the evacuation of extensive acute spinal subdural haematoma

Eur Spine J, 2004 · DOI: 10.1007/s00586-003-0529-8 · Published: August 14, 2003

Simple Explanation

Spinal subdural haematoma is a rare condition where blood collects in the space between the dura mater and the arachnoid mater of the spinal cord, potentially compressing the spinal cord. The standard treatment involves extensive surgery to remove the blood clot, which can be risky. This paper explores using a minimally invasive technique involving a drug called rt-PA to dissolve the clot. Two cases are presented where patients with extensive spinal blood clots were treated with this minimally invasive technique, showing promising results in clot removal and neurological improvement in one patient.

Study Duration

Not specified

Participants

Two patients receiving long-term anticoagulation therapy

Evidence Level

Level 4: Case Reports

Key Findings

1
Topical application of rt-PA allows evacuation of the haematoma through a limited surgical exposure.
2
Decompression of the subdural space by this minimally invasive technique may be advantageous over extensive surgery by minimising surgical exposure, reducing postoperative pain and risk of neuronal injury.
3
Postoperative imaging demonstrated satisfactory decompression in both patients.

Research Summary

This technical note presents a minimally invasive technique using topical rt-PA for evacuating extensive spinal subdural haematomas in two patients on long-term anticoagulation therapy. The technique involves introducing an angiography catheter into the subdural space through a limited laminectomy, followed by thrombolysis and evacuation of the haematoma via intermittent irrigation with rt-PA and saline lavage. Postoperative imaging showed satisfactory decompression in both patients, with one patient experiencing significant neurological function improvement, suggesting this technique may be a useful alternative to conventional surgery, especially for patients with extensive lesions or poor surgical candidacy.

Practical Implications

Minimally Invasive Alternative

Offers a less invasive surgical option for patients with extensive spinal subdural haematomas, potentially reducing morbidity and postoperative pain.

Improved Neurological Outcomes

Demonstrates the potential for neurological function improvement through effective clot evacuation using topical rt-PA.

Treatment for High-Risk Patients

Provides a viable treatment option for patients with poor general health or those who may not be suitable candidates for extensive surgical procedures.

Study Limitations

1
Small sample size (two patients)
2
Lack of long-term follow-up data
3
The rare nature of the condition limits extensive experience and data collection

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