慢性硬膜下血肿MRI表现和不同手术方法与其复发的关系

目的探讨慢性硬膜下血肿(CSDH)术前MRI表现和不同手术方法与其复发的关系.方法回顾分析126例(共149个血肿)CSDH术前MRI资料,依血肿在MRI T1WI的表现分为高信号组(62例)和非高信号组(64例);又依治疗方法的不同,分为单纯钻孔冲洗治疗组和钻孔冲洗 闭式引流治疗组,分别比较其复发率.结果高信号组和非高信号组复发率分为4%和17.6%,高信号组复发率低于非高信号组(P＜0.05);钻孔引流组复发率(6.1%)低于单纯钻孔组复发率(16.4%)(P＜0.05).结论 CSDH术前MRI表现可以预测其复发率,采用闭式引流可以明显地减少其复发率.     

慢性硬膜下血肿20例临床分析

目的 分析慢性硬膜下血肿(CSDH)的临床特征。方法 收集20例CSDH，就其临床表现、发病机制及防治和预后进行临床探讨。结果 CSDH临床症状不典型，尤其是老年人，初诊误诊率达50％，积极治疗治愈率达100％。结论 应重视CSDH的早期诊断。     

外伤性硬膜下积液演变为慢性硬膜下血肿17例临床分析

目的:探讨外伤性硬膜下积液(TSE)患者演变为慢性硬膜下血肿(CSDH)的发生机制。方法:回顾性分析17例外伤性硬膜下积液演变为慢性硬膜下血肿的病人,对其演变机制进行分析。结果:本组17.35 %的外伤性硬膜下积液病例演变为慢性硬膜下血肿,演变时间为伤后19～95 d,平均5 2 d,经单侧颅骨钻孔引流均治愈。结论:外伤性硬膜下积液是慢性硬膜下血肿形成的因素之一,二者有相关性,对外伤性硬膜下积液患者应行动态观察CT或MRI,警惕其演变成慢性硬膜下血肿。     

85例慢性硬膜下血肿临床特征、CT表现与手术结果

目的　进一步探讨慢性硬膜下血肿 (CSDH)的临床特征、CT表现与手术结果。方法　对 85例 CSDH患者的临床特征、CT表现及手术结果进行分析 ,并分老年 CSDH与非老年 CSDH两组进行对照。结果　老年 CSDH组高血压病史、脑血管病史及头晕、反应迟钝、意识障碍、精神症状均明显较非老年性 CDSH组常见 (P<0 .0 5、P<0 .0 1)。老年 CSDH组血肿范围波及三个脑叶以上者 ,形态呈分隔型、密度呈混杂密度者明显较非老年 CSDH组多见 (P<0 .0 5 )。手术后的显效率 ,老年 CSDH组 (75 .4 3% ) ,明显低于非老年 CSDH组 (93.75 % ) ,P<0 .0 1。 2 0例分层、分隔型 CSDH中有 10例经二次手术、多孔引流后痊愈。结论　老年性 CSDH患者多为慢性颅内压增高起病 ,临床症状不典型易被误诊 ,出血量大 ,波及范围广 ,预后差。血液出凝血机制不良因素所致的非老年 CSDH患者更容易被误诊、漏诊 ,需引起高度警惕。要重视分隔型 CSDH的 CT诊断 ,并尽可能采用钻多孔引流或开颅清除术 ,改善其预后。     

改良内镜手术治疗慢性硬脑膜下血肿的疗效

目的 评估改良内镜(MES)手术技术,在气环境下清除慢性硬脑膜下血肿(CSDH)的疗效.方法 65例CSDH患者,采用MES手术治疗27例(A组),钻孔冲洗术38例(B组),术后3d内复查头颅CT,随访3个月～1年,比较两组疗效.结果 A组术后3 d内中线移位完全回复率为92.6%,高于B组的71.1%(P<0.05).B组血肿复发率为23.7%;A组无复发病例.B组中第1次治疗失败4例,其中3例改行开颅血肿清除及包膜切除术治愈;9例复发后再次钻孔冲洗治愈.结论 与钻孔冲洗术比较,MES技术操作简便、微创、视野清晰、血肿清除满意、疗效佳.     

Drug treatment of chronic subdural hematoma

ABSTRACT

Introduction: Chronic subdural hematoma (CSDH) is a common neurosurgical disease, whose incidence has been steadily increasing with our aging population. While not common, CSDH can also occur in children. CSDH is often associated with traumatic head injury, but its underlying mechanism remains poorly understood. The first line treatment for CSDH is surgery. However, surgery is contraindicated in some patients and has a high rate of recurrence. Effective non-surgical treatment is therefore highly desirable.

Areas covered: This review discusses the pathogenesis of CSDH and drugs that have been used to treat CSDH either as monotherapy or an adjuvant to surgery, including controlled clinical trials.

Expert opinion: The pathophysiology of CSDH remains poorly understood. Developing effective drug treatments is therefore challenging. Most drugs discussed in this review are evaluated in small clinical studies without sufficient sample size and controls for confounding variables. More controlled clinical trials are therefore needed to carefully evaluate drugs for the non-surgical treatment of CSDH, especially for drugs targeting specific pathogenic pathways of CSDH.     

Organized chronic subdural haematoma with a thick calcified inner membrane successfully treated by surgery: a case report

The optimal surgical procedure for patients with calcified and organized chronic subdural haematoma (CSDH), or "armoured brain", has not been established because it is difficult to obtain good re-expansion of the brain after surgery. We present herein the case of a 32-year-old woman with huge calcified CSDH manifesting as refractory headache, periods of unconsciousness, and unsteady gait who obtained favourable results after craniotomy. Thinning of the thick calcified inner membrane using high-speed air drilling was performed after removal of the organized CSDH. The patient obtained good re-expansion after surgery. This observation illustrates that it is possible to perform such a surgery even on a huge calcified CSDH.     

老年慢性硬脑膜下血肿术后并发症的治疗分析

目的探讨老年慢性硬脑膜下血肿(CSDH)术后并发症出现的原因及应对措施。方法分析20例出现术后并发症的老年CSDH患者的临床资料和治疗过程。结果老年CSDH术后并发症与患者脑梗死及脑萎缩程度、手术过程、术后管理及患者基础身体状况有关。结论对老年CSDH术后并发症的防治应全面评估患者身体状况,严格闭式引流及精细术后管理以共同提高疗效。     

慢性硬膜下血肿术后并发症及复发原因的研究分析

目的:研究使用钻孔引流治疗慢性硬膜下血肿术后患者出现并发症的情况及复发原因。方法:回顾性分析我院2006年1月～2011年12月经钻孔引流术治疗的255例CSDH患者的临床资料,采用CT对CSDH患者进行扫描,对患者血肿进行分型,探讨研究哪些血肿易发生误诊及复发。调查患者术后治愈情况,分析研究并发症、复发原因及防治措施。结果:255例患者共治愈251例,4例死亡,死亡原因分别是弥散性血管内凝血1例、肺部感染2例及癫痫发作1例。并发症发生19例,其中,癫痫3例,脑卒中4例,血肿复发11例,张力性气颅1例。结论:采用钻孔闭式引流治疗CSDH较为安全,但仍存在一些并发症和复发情况,充分认识和预防这些并发症能进一步提高CSDH患者的治愈率,降低死亡率。     

87例慢性硬膜下血肿钻孔引流术临床治疗体会

目的 探究慢性硬膜下血肿(CSDH)病人颅骨钻孔引流术的疗效和预后.方法 对收治的87例CSDH病人临床资料进行回顾性研究,并分析应用颅骨钻孔引流手术治疗后的随访结果.结果 术后87例CSDH病人临床不适症状消失或明显改善,其中83例血肿完全清除,4例血肿少量残留.随访3~6个月后,2例并发无明显症状的硬膜下积液,1例术后血肿复发.结论 颅骨钻孔引流术是治疗CSDH安全可靠、疗效确切的首选方法.