慢性硬膜下血肿钻孔引流术后复发的危险因素

目的 探讨慢性硬膜下血肿（CSDH）钻孔引流术后复发的危险因素。方法 回顾性分析2018年8月至2022年3月钻孔引流术治疗的188例CSDH的临床资料。术后6个月随访判断复发情况,采用多因素logistic回归模型分析术后复发的危险因素。结果 术后6个月,17例复发,复发率为9.04%;171例未复发。多因素logistic回归分析显示,血肿厚度>25 mm、双侧血肿、高密度血肿是CSDH钻孔引流术后复发的独立危险因素（P<0.05）。结论 CSDH钻孔引流术后具有一定的复发率。如果存在血肿厚度>25 mm、双侧血肿、高密度血肿等情况,CSDH病人钻孔引流术后复发的风险明显增高,应采取针对性措施预防复发,并密切随访。     

高龄慢性硬膜下血肿术后复发的危险因素分析

目的探讨高龄慢性硬膜下血肿(CSDH)钻孔引流术术后血肿复发的潜在危险因素。方法选择中国科学技术大学附属第一医院2015年4月～2017年6月之间接受钻孔引流术治疗的高龄CSDH患者129例,将其分为复发组和未复发组,对各变量进行单因素及Logistic多因素回归分析。结果 129例CSDH患者钻孔术后6个月内共有13例复发(10.08%)。通过单因素及Logistic多因素回归分析显示,患者的血肿类型(混杂密度型)、血肿厚度及糖尿病与CSDH钻孔术后复发有关;而血肿混杂密度型(P=0.019,OR=2.954)和糖尿病(P=0.011,OR=24.580)是CSDH钻孔引流术后复发的独立危险因素。结论混杂密度型血肿和糖尿病是高龄CSDH钻孔引流术术后复发的独立危险因素,可根据患者的具体临床特点提供个体化的治疗及随访方案,尽量提高高龄CSDH患者的生活质量。     

复发性慢性硬膜下血肿的MRI和CT诊断比较及影响因素

目的 探讨复发性慢性硬膜下血肿（CDH）的磁共振（MRI）和计算机体层扫描（CT）诊断价值及影响因素.方法 收集我院2009-08-2013-08慢性硬膜下血肿CSDH术后复发患者共56例,其中双侧血肿23例;行MRI及CT检查比较其对复发血肿的诊断意义及复发血肿影响因素.结果 MRI及CT在复发血肿诊断上比较差异有统计学意义（P＜0.05）.Logistic回归分析结果提示患者的年龄、双侧血肿、脑萎缩及脑组织回弹速度、术后血肿残留量与术后再出血有相关性,而患者性别、口服阿司匹林及硫酸氢氯吡格雷片和引流时间与术后再出血无明显相关性.结论 MRI对慢性硬膜下血肿的复发诊断优于CT,高龄、双侧血肿、脑萎缩,脑组织回弹速度越慢、术后血肿残留量是术后血肿复发的相关因素.     

慢性硬膜下血肿的CT影像学特征对其术后复发的影响

目的 研究CT影像学特征对慢性硬膜下血肿(CSDH)术后复发的影响及其之间的关系.方法 回顾分析272例经手术治疗的CSDH患者的临床资料.采用单因素分析CSDH的CT影像指标(血肿密度、厚度及中线结构移位)与其术后复发的关系;对单因素分析有统计学意义的指标纳入多因素Logistic回归模型,分析CSDH复发的影响因素...     

80岁以上单侧多分隔型慢性硬膜下血肿手术效果分析

目的 通过与钻孔引流术比较，研究硬通道穿刺引流术治疗高龄多分隔型慢性硬膜下血肿（chronic subdural hematoma,CSDH）的有效性及安全性。方法 21例80岁以上单侧多分隔型CSDH采用钻孔引流术治疗9例（钻孔组），采用硬通道穿刺引流术治疗12例（硬通道组），比较两组手术时间、术后1周血肿清除率、术后并发症及术后3个月血肿复发情况。结果 两组患者均顺利完成手术，钻孔组手术时间50～95 min，平均（78±14）min，硬通道组22～40 min，平均（29±5）min，差异有统计学意义（P<0.05）；术后1周血肿清除率钻孔组92%～100%，平均（96%±3%），硬通道组90%～100%，平均（94%±3%），差异无统计学意义（P>0.05）。术后并发症钻孔组无癫痫发作，硬通道组癫痫发作1例（8.3%），差异无统计学意义（P>0.05）；两组患者均无颅内占位性积气、脑实质损伤及颅内感染等其他并发症发生。术后3个月钻孔组无血肿复发，硬通道组复发3例（25%），差异无统计学意义（P<0.05）。结论 硬通道穿刺引流术治疗高龄多分隔型CSDH安...     

慢性硬膜下血肿患者的临床预后和复发率分析

目的分析慢性硬膜下血肿（CSDH）患者的临床预后及复发率。 方法回顾性分析青岛市西海岸新区人民医院神经外科自2012年6月至2017年12月收治的117例CSDH患者的一般资料、CT表现、血肿量及手术方式,分析其预后复发的情况。 结果本次入组117例患者,平均随访3个月,104例患者预后良好,13例患者复发。单因素分析显示患者年龄、术前CT分型和血肿量差异有统计学意义（P<0.05）,手术方式对预后复发的影响差异无统计学意义（P>0.05）;多因素Logistics回归分析进一步发现患者年龄、术前CT影像及血肿量与患者血肿的复发相关。 结论CT分型可作为CSDH手术方式和判断预后的重要指标,根据术前CT征象以及患者的病情选择最优的治疗方案,降低血肿复发率。     

慢性硬膜下血肿钻孔引流术后复发的危险因素分析

目的探讨慢性硬膜下血肿(chronic subdural hematoma,CSDH)钻孔引流术后复发的危险因素。方法 2015年1月~2016年12月手术治疗的176例CSDH患者,其中复发患者12例。对比两组患者的年龄、血肿的影像学特征、服药情况,术后头颅CT表现等可能的危险因素;并结合有关文献进行分析。结果未复发患者的平均年龄(54.3±19.2)岁,复发患者的平均年龄(73.2±17.4)岁(P=0.01)。37例双侧血肿患者中复发4例(P=0.04)。服用抗凝药物27例患者中,复发4例(P=0.03)。39例术前CT示血肿密度不均一患者中复发9例(P=0.01);术后CT复查脑复张不全患者27例中,有7例复发(P=0.02);15例大量颅内积气患者中复发3例(P=0.04)。117例术中引流管置于血肿腔前部患者中复发5例,49例引流管留置于血肿腔后部患者中复发7例(P=0.008)。结论高龄、双侧血肿、服用抗凝药物、血肿密度不均一、引流管留置于血肿腔后部、术后颅内积气和脑复张欠佳是CSDH患者钻孔引流术后复发的危险因素。     

慢性硬膜下血肿术后复发的相关因素分析

目的探讨影响慢性硬膜下血肿(CSDH)术后复发的因素。方法回顾我科自2006年3月至2010年9月手术治疗243例CSDH患者的临床特点、影像学表现、手术方法及术后处理,Logistic回归分析术后复发相关因素。结果术后复发37例,复发率为15.23%。复发的37例患者平均年龄70岁。其中因凝血功能障碍复发者28例;头颅CT血肿为高密度者复发6例,等密度者复发14例,低密度者复发4例,混杂密度者复发13例;因术后大量颅内积气复发者3例;血肿位于单侧复发19例,双侧复发18例。结论患者的年龄,凝血功能障碍,血肿的性质、部位,术后颅内积气和引流量的多少影响CSDH患者的预后。     

慢性硬膜下血肿术前影像学分型和手术治疗

目的 探讨慢性硬膜下血肿（CSDH）的术前影像学分型以及手术治疗。方法 自2008年1月至2014年3月收治CSDH患者246例,根据术前头颅CT、MRI特征分为5型:低密度型、等密度型、高密度型、混杂密度型及分隔型,并依据分型采用不同手术方式治疗。结果 本组效果良好（Markwalder分级Ⅰ~Ⅱ级）率为93.5%,总并发症发生率为6.5%。低密度型术后5例血肿复发,等密度型1例复发,高密度型1例复发,混杂密度型3例复发;分割型发生癫痫1例。结论 根据CSDH患者术前影像学分型,选择合理的手术策略,并予以个体化治疗,对于治疗CSDH具有重要意义。     

慢性硬膜下血肿硬膜下引流时间与血肿复发的关系

目的 探讨慢性硬膜下血肿（CSDH）硬膜下引流时间与血肿复发的关系。方法 回顾性分析2017年3月至2022年10月单钻孔引流术治疗的114例CSDH的临床资料。根据术后引流时间分为三组：0～8 h组（n=47）、9～16 h组（n=33）、17～24 h组（n=34）。随访90 d,观察术后血肿复发情况。结果 144例中,术后复发20例,死亡4例;其中0～8 h组血肿复发14例（29.79%）,死亡3例（6.38%）;9～16 h组血肿复发4例（12.12%）,无死亡病例;17～24 h组血肿复发2例（5.88%）,死亡1例（2.94%）。0～8 h组血肿复发率显著高于9～16 h组和17～24 h组（P<0.05）,而三组病死率无统计学差异（P>0.05）。多因素logistic回归分析显示,引流时间较短是术后血肿复发的独立危险因素（P<0.05）。结论 CSDH单钻孔引流术后硬膜下引流的早期终止与血肿复发风险增加有关。早期监测术后硬膜下引流时间并预防早期引流终止可能有助于降低血肿复发率。     

影响慢性硬膜下血肿钻孔引流术后复发的因素分析

目的探讨影响慢性硬膜下血肿钻孔引流术后复发的相关因素。方法回顾性分析应用钻孔引流术治疗的160例慢性硬膜下血肿患者的临床资料,采用多因素Logistic回归分析影响术后复发的相关因素。结果 160例患者中,术后复发14例(8.75%),复发时间15天~12月。单因素分析显示年龄(P=0.049)、血肿体积(P=0.004)、术前中线移位(P=0.019)及血肿厚度(P=0.024)与术后复发有关。多因素分析显示血肿体积(P=0.008)是影响患者术后复发的独立因素。结论慢性硬膜下血肿钻孔引流术后复发因素有许多,血肿体积可作为评估复发因素的独立指标。     

Prediction of postoperative recurrence of chronic subdural hematoma using quantitative volumetric analysis in conjunction with computed tomography texture analysis

Chronic subdural hematoma (CSDH) is a common disease in older individuals with a substantial rate of recurrence. The mechanism of CSDH recurrence remains unclear. This study aimed to detect imaging parameters that could indicate the risk for CSDH recurrence by using quantitative volumetric analysis and computed tomography (CT) texture analysis (CTTA).Clinical and imaging parameters were retrospectively investigated in 147 newly diagnosed CSDH lesions in 114 patients surgically treated at the Keio University Hospital during a 6-year period. For CT images, quantitative volumetric and texture analyses were performed. Hematoma volume, postoperative air volume, hematoma density, and texture parameters including kurtosis, skewness, and entropy were evaluated and compared with CSDH recurrence rate. Data were statistically evaluated, and a difference of p < 0.05 was considered significant.Reoperation for CSDH recurrence was required in 27 sides (18.4%) of 26 patients. Multivariate analysis showed that postoperative hematoma volume and postoperative hematoma density were independent risk factors for symptomatic CSDH recurrence that required reoperation. Postoperative hematoma volume, postoperative significant residual air, and postoperative hematoma density were also identified as independent risk factors for potential CSDH recurrence. Preoperative hematoma entropy was prone to be associated with both symptomatic and potential CSDH recurrence in univariate analysis, but not in multivariate analysis because of confounding factors.Quantitative volumetric analysis and CTTA could aid in distinguishing individuals at risk for CSDH recurrence.     

Development of a prognostic scoring system to predict risk of reoperation for contralateral hematoma growth after unilateral evacuation of bilateral chronic subdural hematoma

Bilateral chronic subdural hematoma (bCSDH) is frequently drained unilaterally when the contralateral CSDH is small and asymptomatic. However, reoperation rates for contralateral CSDH growth can be high. We aimed to develop a prognostic scoring system to guide the selection of suitable patients for unilateral drainage of bCSDH. Data were collected retrospectively across three tertiary hospitals from 2010 to 2017 on all consecutive bCSDH patients aged 21 or above. Predictors of reoperation were identified using multivariable logistic regression. A prognostic score was developed and internally validated. 240 bCSDH patients were analyzed. 98 (40.8%) underwent unilateral and 142 (59.2%) underwent bilateral evacuation. Clinical outcomes were comparable between the unilateral and bilateral evacuation groups. Within the unilateral evacuation group, 4 (4.1%) had a reoperation for contralateral CSDH growth. Reoperation for contralateral CSDH was predicted by preoperative use of anticoagulants (OR = 15.0, 95% CI: 1.49–169.15, p = 0.017). Complete resolution of contralateral CSDH was predicted by its preoperative maximum width, with a cut-off of 9 mm producing the highest sensitivity and specificity (OR = 4.17 for ≤9 mm, 95% CI: 1.54–11.11, p = 0.004). Using our prognostic score, reoperation rate for contralateral CSDH was 1.6%, 3.6%, 16.7%, and 50.0% in low-risk, moderate-risk, high-risk and very high-risk patients, respectively. With each increase of 1 in the prognostic score, patients were 4 times as likely to undergo reoperation for contralateral CSDH (OR = 3.98, 95% CI: 1.36–13.53, p = 0.013). Our proposed risk score may be used as an adjunct in clinical decision making for bCSDH patients undergoing unilateral evacuation.     

单侧慢性硬膜下血肿钻孔引流术后复发的临床预测模型建立与验证

目的 研究基于临床资料建立并验证单侧慢性硬膜下血肿(CSDH)钻孔引流术后复发的预测模型.方法 纳入采用钻孔引流治疗的366例单侧CSDH患者.根据首次钻孔后3个月内是否CSDH复发,将患者分为复发组和非复发组;分析比较与CSDH术后复发可能相关的15项因素.采用最小绝对收缩和选择算子(LASSO)回归来降低数据维度和...     

外伤性硬膜下积液在向慢性硬膜下血肿转化过程中的相关因素配对回归分析

目的 回顾性研究外伤性硬膜下积液向慢性硬膜下血肿(CSDH)转化过程中相关因素的影响.方法 对22例慢性硬膜下血肿中明确有外伤性硬膜下积液(TSE)的患者根据性别、年龄、职业配对单纯外伤性硬膜下积液的患者(1∶2配对,共44例).多因素回归分析外伤性硬膜下积液转化为慢性硬膜下血肿组与单纯外伤性硬膜下积液组间在硬膜下积液CT值、积液部位、积液体积、凝血功能4种相关因素间有无差异.结果 外伤性硬膜下积液转化为慢性硬膜下血肿组与单纯外伤性硬膜下积液组间患者的伤后硬膜下积液CT值、积液部位间差异存在统计学意义.结论 外伤性硬膜下积液存在向慢性硬膜下血肿转化的趋势,患者硬膜下积液的CT值相对较高、积液位于额颞部患者这一趋势尤为明显.     

Fatty acid composition of the chronic subdural hematoma: with reference to its recurrence.

The fatty acid composition of aspirated chronic subdural hematoma (CSDH) was measured by gas liquid chromatography and the relationship between fatty acid and recurrence of the hematoma was assessed. Thirty patients with CSDH were operated on through a single burr-hole; 4 patients developed recurrent hematoma (13%). The lipid composition of CSDH was mainly phosphatidylcholine, sphingomyelin, cholesterol, free fatty acid, triacylglycerol and cholesterol ester. The fatty acid constituents were palmitic, stearic, oleic, linoleic, arachidonic and docosahexanoeic acids. Analysis of the polyunsaturated fatty acids demonstrated that hematoma taken from patients with recurrent CSDH contained more linoleic acid (n-6) than those with non-recurrent CSDH. Linoleic and arachidonic acids are known to induce angiogenesis in cultured aortic endothelial cells. Change in fatty acid composition of recurrent hematoma might be associated with rebleeding from the hematoma capsule.     

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 回顾分析了126例(共149个血肿)CSDH术前MRI资料,依血肿在MRI T_1 WI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别为4％和17.6％,两者相较,相差显著(P<0.05);钻孔引流和单纯钻孔复发率分别为6.1％和16.4％,两者相较,亦相差显著(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。     

Clinical Characteristics and Current Managements for Patients with Chronic Subdural Hematoma : A Retrospective Multicenter Pilot Study in the Republic of Korea

ObjectiveChronic subdural hematoma (CSDH) is a common disease in neurosurgical departments, but optimal perioperative management guidelines have not yet been established. We aimed to assess the current clinical management and outcomes for CSDH patients and identify prognostic factors for CSDH recurrence. MethodsWe enrolled a total of 293 consecutive patients with CSDH who underwent burr hole craniostomy at seven institutions in 2018. Clinical and surgery-related characteristics and surgical outcomes were analyzed. The cohort included 208 men and 85 women. ResultsThe median patient age was 75 years. Antithrombotic agents were prescribed to 105 patients. History of head trauma was identified in 59% of patients. Two hundred twenty-seven of 293 patients (77.5%) had unilateral hematoma and 46.1% had a homogenous hematoma type. About 70% of patients underwent surgery under general anesthesia, and 74.7% underwent a single burr hole craniostomy surgery. Recurrence requiring surgery was observed in 17 of 293 patients (5.8%), with a median of 32 days to recurrence. The postoperative complication rate was 4.1%. In multivariate analysis, factors associated with CSDH recurrence were separated hematoma type (odds ratio, 3.906; p=0.017) and patient who underwent surgery under general anesthesia had less recurrence (odds ratio, 0.277; p=0.017). ConclusionThis is the first retrospective multicenter generalized cohort pilot study in the Republic of Korea as a first step towards the development of Korean clinical practice guidelines for CSDH. The type of hematoma and anesthesia was associated with CSDH recurrence. Although the detailed surgical method differs depending on the institution, the surgical treatment of CSDH was effective. Further studies may establish appropriate management guidelines to minimize CSDH recurrence.