FEASIBILITY, SAFETY AND EFFECTIVENESS OF SUBDURAL TRANEXAMIC ACID IRRIGATION IN THE MANAGEMENT OF CHRONIC SUBDURAL HEMATOMA: A PRELIMINARY STUDY

SUBDURAL TRANEXAMIC ACID IRRIGATION

Abstract

Background: The optimal management of chronic subdural hematoma (CSH) remains a topic of debate, as there is a lack of consensus on the optimal treatment approach. Topical application of tranexamic acid (TXA) to bleeding surfaces has shown potential in inhibiting local fibrinolysis and reducing bleeding, with minimal systemic effects. This study aims to evaluate the feasibility, safety, and effectiveness of subdural TXA irrigation in the management of CSH.

Methodology: A prospective analysis of the clinical data from 18 patients with CSH was conducted with a minimum 6-week period of follow-up. Clinical and radiological follow-up was performed at regular intervals (1 week, 3 and 6 weeks after surgery) to monitor recurrence and neurological improvement. The primary outcome measure was the recurrence of CSH requiring surgical intervention, while secondary outcomes included Clavien-Dindo grade (CDG) and neurological outcome assessed using the Markwalder grading scale and Glasgow Outcome Scale Extended scores at 6 weeks post-operatively.

Results: The study population consisted of 11 males, with a mean age of 59.5 years (range: 30-88 years). There were no cases of CSH recurrence or mortality observed. All patients exhibited a CDG score of less than 3 and significant neurological improvement at 6 weeks post-surgical intervention.

Conclusions: Our preliminary findings demonstrate acceptable postoperative outcomes with the off-label use of TXA for subdural irrigation in CSH. These results suggest that subdural irrigation of TXA could be considered as a primary surgical treatment option for patients with CSH. This study highlight the promising nature of this novel approach and emphasize the need for future prospective randomized controlled studies to confirm these preliminary data.