慢性硬脑膜下血肿钻孔引流的改进

一、资料与方法 1．一般资料：本组13例，置管14人次。男11例，女2例，年龄36—84岁，平均69岁。有外伤史11例，原因不明2例，受伤距出现症状时间最短1个月，最长3月余。所有病人均经头颅CT确诊慢性硬脑膜下血肿（CSDH）。     

慢性硬脑膜下血肿的诊治

慢性硬脑膜下血肿(CSDH)是指位于硬脑膜和蛛网膜之间有完整包膜的血肿。我院1990年10月～99年6月对130例慢性硬脑膜下血肿进行手术治疗。现总结、分析如下。     

慢性硬脑膜下血肿手术治疗21例体会

慢性硬脑膜下血肿多系外伤引起,神经外科临床上常见,我院自1995年以来收治21例,均采用手术治疗,效果良好,现报告如下.     

负压引流治疗慢性硬脑膜下血肿

<正>1临床资料1.1一般资料2001~2009年治疗慢性硬膜下血肿37例,其中男25例,女12例;年龄36~84岁,平均56岁。有外伤史31例,原因不明6例。病程1~3个月。     

微创钻孔穿刺引流术治疗慢性硬脑膜下血肿

慢性硬脑膜下血肿是指头部外伤三周以后出现症状,位于硬脑膜与蛛网膜之间、具有包膜的颅内血肿。我们复习了大宗经过各种手术治疗的慢性硬脑膜下血肿病例,对其中每一种方法均进行了深入探讨,认为采用北京朝阳医院神经外科研制的穿刺针治疗该病具有更好的效果。现将以此法治疗的30例慢性硬脑膜下血肿病人情况总结报告如下。1.1一般资料男性22例,女性8例。年龄20～74岁,平均53岁。受伤原因:打击伤12例,坠落伤2例,跌伤8例,车祸伤3例,不明原因5例。血肿部位:以颞顶为主13例,以额颞为主2例,以额顶为主5例,以颞枕为主3例,以顶枕为主2例,以颞枕顶为…     

慢性硬脑膜下血肿钻孔引流术后并发症的预防

目的探讨慢性硬脑膜下血肿钻孔引流术后并发症的预防。方法回顾性分析1997—2007年275例慢性硬脑膜下血肿钻孔引流术并发症的预防与治疗。结果本组275例患者治愈267例,死亡8例。结论慢性硬脑膜下血肿钻孔引流术预后并发症少,方法简单有效。     

慢性硬脑膜下血肿钻孔T型管引流的临床体会

我院自2004年3月以来,对慢性硬脑膜下血肿(CSDH)病人钻孔术后的普通硅胶管改用胆道手术后引流的T型管,从而收到了很好的效果,现将已应用44例病人的临床体会介绍如下:1材料与方法1.1材料无菌14号“T”型引流管一根。1.2方法全组局麻,选择顶结节或邻近处为钻颅点,切开硬脑膜前,根     

慢性硬脑膜下血肿的诊断与治疗体会

目的探探讨慢性硬膜下血肿的临床特点及诊治要点。方法回顾性分析经钻孔引流术治疗的97例慢性硬膜下血肿患者的临床资料。结果 97例患者均治愈出院。术后并发症包括硬膜下积液3例,颅内血肿4例,张力性气颅3例,精神障碍6例,癫痫发作4例。血肿复发5例。结论头颅CT平扫是诊断慢性硬膜下血肿的首选检查。对于有症状的慢性硬膜下血肿患者,应采取手术治疗,并积极防治手术并发症。     

以精神症状首发的慢性硬脑膜下血肿1例报道

患者男,65岁,因胡言乱语3天,卧床不语不动1天,于2002年3月13日收入院。患者于3天前因与别人吵架生气后出现头痛、头晕,后逐渐言语怪诞,胡言乱语,不认识家里人,分不清时间、地点,称听见死去的人说话并与之交谈,可看到千里之外的人,吃饭不知饥饱,不知料理个人卫生。于     

慢性硬脑膜下血肿钻孔引流术后死亡病例分析

目的 总结慢性硬脑膜下血肿钻孔引流术后死亡的原因.方法 回顾性总结16例采用钻孔引流术治疗慢性硬脑膜下血肿后死亡病例的临床资料.结果 共有患者16例,男12例、女4例,平均年龄(75±11)岁;占同期钻孔引流手术治疗慢性硬脑膜下血肿的484例的3.3%;单侧血肿13例、双侧血肿3例.12例死于内科并发症,3例死于手术相关并发症,1例死于意外;死亡时间平均为术后(36±89)d.结论 注重患者的全身状况和防治手术相关的并发症是减少钻孔引流术治疗慢性硬脑膜下血肿术后死亡的关键.     

双侧慢性硬膜下血肿的诊治

目的 探讨双侧慢性硬膜下血肿(BCSDH)的诊断和治疗的特殊性。方法 对我科自1988～1998年共收治的32例BCSDH病人的资料进行回顾性分析。这32例病人中5例行单侧钻孔引流，27例行双侧钻孔引流。结果 治愈30例，1例原有神经系统功能不良，恢复不明显，1例死于结肠癌合并症。结论 引流方法、血肿腔的处理和气颅的预防等使得治疗BCSDH的情况比较复杂，由于起病的原因不同，导致预后差异。     

117例老年人慢性硬膜下血肿的诊治

目的 探讨老年人慢性硬膜下血肿(CSDH)的临床特点和治疗经验.方法 对117例病人的临床特点、手术方法和结果进行回顾性分析.结果 多有轻微头部外伤病史,以颅内压增高、偏侧障碍为主要临床表现,CT检查以低密度和混杂密度为主,MRT1、T2加权像表现为高信号.钻孔引流113例,开颅血肿清除4例.术后痊愈116例,因并发症死亡1例.结论 CT或MRI检查有助于早期明确诊断.钻孔引流术简便、安全、有效,是首选方法.老年人要注意全身状况.     

慢性硬膜下血肿3种治疗方法的疗效比较

目的:对119例慢性硬膜下血肿(CSDH)的临床资料,其中包括28例类固醇治疗成功的病例,进行比较,以期得出治疗该病的最有效方法。方法:将所有病例分成3个治疗组:冲洗引流组(A组,50例);冲洗抽吸引流组(B组,41例)和激素治疗组(C组,28例)。有91例接受手术治疗。28例接受类固醇治疗。对复发率等进行两两比较,采用Two-WayANOVA方差分析进行数据统计分析。结果:日常生活能力改善ADL评分,A组和B组差异无显著统计学意义;C组明显长于A组和B组(PA-C=0.035,PB-C=0.040)。复发率B组明显相似文献   

Bilateral Chronic Subdural Hematoma Contaminated with Klebsiella Pneumoniae : An Unusual Case

This article presents the case of a bilateral chronic subdural hematoma which was contaminated with Klebsiella pneumoniae and resulted in a life-threatening central nervous system infection. After repeated of bilateral burr-hole drainage, the patient became hyperpyrexic and drowsy. Suppuration within the subdural space was suspected and then the patient underwent bilateral fronto-temporo-parietal craniotomies, and pus was evacuated. Its cultures revealed Klebsiella pneumoniae. Intravenous meropenem was given for 6 weeks. He recovered completely. Microorganisms like Klebsiella pneumoniae may directly infect the subdural space with iatrogenic contamination.     

Electroconvulsive Therapy and Chronic Subdural Hematoma

An elderly female patient with major depression was found to have an asymptomatic chronic subdural hematoma. Electroconvulsive therapy (ECT) resulted in full remission of her depression without neurological deterioration. The use of ECT in patients with cerebral lesions is discussed.     

Postoperative Course and Recurrence of Chronic Subdural Hematoma

Objective

Chronic subdural hematoma (CSDH) is known to have a significant recurrence rate. There are different criteria defining the recurrence of CSDH. We evaluated the postoperative course of CSDH and tried to propose the reasonable criteria of recurrence.

Methods

We retrospectively examined the medical records and pre- and postoperative CT scans of 149 consecutive patients who underwent surgery from January 2005 to December 2009. Diagnosis was confirmed by CT scanning or MRI. The postoperative courses were either resolved or recurrent. The resolved CSDH was one of the three types; early resolution, delayed resolution, or late resolution. The recurrent CSDH was one of the four types; recurrence without resolution, early recurrence after resolution, late recurrence after resolution, or recurrent-and-resolved type.

Results

The CSDH was resolved within 30 days after surgery in 58 (39%) patients, between 1 to 3 months in 62 (42%), and after 3 months in 11 (7%) patients. The CSDH was recurred in 18 (12%) patients. Late resolution or recurrence was more common in the aged. The recurrent hematoma was seen on the same side in 11 patients, on the different side in 7 patients. Recurrence was significantly more common in the thick hematomas.

Conclusion

For a working criteria of the recurrence of CSDH, we propose the early recurrence as return of symptoms or reaccumulation of the hematoma after a surgery within 3 months regardless of the location, amount or repeated operations. The late recurrence can be defined as reappearance or enlargement of a liquefied hematoma within the cranial cavity surrounded by the membranes or persistent CSDH beyond 3 months after surgery.     

Bilateral Subdural Hematoma Following Implantation of Intrathecal Drug Delivery Device

Objectives: To report a case of bilateral subacute subdural hematoma following implantation of intrathecal drug delivery device. Materials and Methods: We present here the case of a 41‐year‐old woman with multiple sclerosis and intractable spasticity who developed a bilateral subacute subdural hematoma after the placement of an intrathecal catheter connected to a programmable pump for baclofen infusion. Results: Surgical drainage of the hematoma resulted in full neurologic recovery. This complication due to intracranial hypotension following lumbar puncture has been previously reported only once in patients with implanted intrathecal drug delivery device. Conclusions: Medical and nursing staff dealing with intrathecal therapy should be aware of this potentially severe complication.     

The Surgical Treatment of Three Young Chronic Subdural Hematoma Patients with Different Causes

Chronic subdural hematoma (CSDH), which rarely happens in the young, is thought to be a disease of the elderly. Whereas unspecific symptoms and insidious onset in juveniles and young adults, as a result of its relative low morbidity, CSDH is usually neglected even undertreated in the young. Through the three cases and review of the current literature on this subject, we tried to illustrate the clinical and etiopathological characteristics of this entity and find out the most appropriate treatment strategy. We report three young CSDH patients with different but similar symptoms. The present histories, tests and examinations revealed different predisposing factors accounting for the genesis of CSDH. Their preoperative symptoms were all resolved with burr hole and drainage operation. Juveniles and young adults suffering from CSDH differ from that of their elderly counterparts in their clinical and etiopathological characteristics. Although trauma is the most important risk factor in young and old CSDH patients, some other predisposing factors may exist. Burr hole and drainage surgery could resolve the problem most of the time. But further tests and examinations even specific management should be made in some cases.     

Spinal Subdural Hematoma Associated with Intracranial Subdural Hematoma

The simultaneous occurrence of an intracranial and a spinal subdural hematoma (SDH) is rare. We describe a case of cranial SDH with a simultaneous spinal SDH. An 82-year-old woman visited the emergency room because of drowsiness and not being able to walk 6 weeks after falling down. A neurological examination showed a drowsy mentality. Brain computed tomography showed bilateral chronic SDH with an acute component. The patient underwent an emergency burr-hole trephination and hematoma removal. She exhibited good recovery after the operation. On the fourth postoperative day, she complained of low-back pain radiating to both lower limbs, and subjective weakness of the lower limbs. Spine magnetic resonance imaging revealed a thoracolumbosacral SDH. A follow-up spinal magnetic resonance imaging study that was performed 16 days later showed a significant decrease in the size of the spinal SDH. We discuss the pathogenesis of this simultaneous occurrence of spinal and cranial SDH.