Abstract
Background and Study Aims Cranioplasty is a cosmetic procedure utilized to reconstruct cranial defects in patients
following decompressive craniectomy. Epidural hematomas are a common complication
of cranioplasty and often require surgical drainage. However, repeated surgery compromises
patient safety and delays recovery.
Material and Methods We investigated the development of epidural hematomas among 131 patients who underwent
cranioplasty. Then we explored the efficacy of urokinase (UK) injection for the noninvasive
treatment of epidural hematomas. We observed that 15 patients presented with epidural
hematoma following cranioplasty. UK (30,000 IU/3 mL) was injected into the hematoma
cavity twice every 12 hours in the first postoperative day. Next we closed the subgaleal
drain for 1.5 hours and connected it with a negative-pressure ball on full vacuum
to allow drainage. Binary logistic regression analysis was used to evaluate the risk
factors associated with the development of epidural hematomas.
Results Our findings demonstrated that a sunken skin flap was a risk factor for epidural
hematoma formation (p = 0.006). The decrease in epidural hematoma volume was 35.27 ± 7.27 mL in the first
12 hours on postoperative day 1 after UK treatment. All treated patients whose Glasgow
Coma Scale score did not significantly change despite the epidural hematoma had an
uneventful recovery without additional complications and were discharged from the
hospital, except for one patient.
Conclusion Fibrinolytic therapy can be considered an optional treatment for postoperative epidural
hematoma associated with cranioplasty, especially in patients who refused further
operative treatment or who are not optimal candidates for a second surgery.
Keywords
fibrinolytic therapy - urokinase - cranioplasty - acute epidural hematoma
