慢性硬脑膜下血肿引流手术的改进

钻孔冲洗引流术是目前治疗慢性硬脑膜下血肿的首选方法,但仍有一些严重并发症影响其病程和预后。笔者近五年来对该方法作了一些改进,手术40例,无1例发生并发症,报告如下。1手术方法应用局部麻醉,选择平卧时血肿较低位处钻孔,扩大成2.5cm×2.5cm左右小骨窗,骨蜡涂布止血,硬膜悬吊2针,从切口旁置入引流管、“十”字切开硬脑膜置入引流管于血肿腔后立即缝合切口,开放引流管缓慢放出硬膜下血肿。双侧者先行血肿多的一侧手术,双侧手术后,两侧引流管同一高度同时缓慢放液。血肿量超过100ml者,初次放出三分之二左右后夹管,3～6h后再开放自然引流。…     

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。     

微创穿刺治疗老年人慢性硬脑膜下血肿108例临床分析

目的采用微创穿刺术治疗老年人慢性硬脑膜下血肿（CSDH）。方法依据CT定位,确定血肿最大层面,应用YL-1型一次性颅内血肿粉碎穿刺针引流适量血肿后,用生理盐水等量冲洗,至冲洗液清亮后连接引流袋,开放引流,1～4d拔针。结果本组108例患者采用了微创手术均一次穿刺成功,术后全部患者颅内高压、偏瘫、失语、意识障碍迅速好转,脑疝消失,随访6个月未见复发和并发症。结论采用微创穿刺术治疗老年人CSDH,只需局麻,操作简单,安全,损伤小,值得推广。     

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。     

老年人慢性硬脑膜下血肿

报道５０例经脑ＣＴ扫描证实的老年慢性硬脑膜下血肿。３２例有不同程度外伤史，但高颅压症状轻微。１７例初诊时接近诊断。１９例初诊为脑血管病；另１４例，误为其它，手术治疗４０例效果良好；非手术治疗１０例中基本治愈６例，死亡４例尸检诊断。     

老年高血压慢性硬脑膜下血肿56例分析

老年人在高血压的基础上发生慢性硬膜下血肿临床上并不少见。我科自1998年1月至2002年2月共收治老年人慢性硬膜下血肿98例，其中56例伴有高血压，占57．14％。现报告如下，并结合有关文献对其外伤史、临床特点以及处理原则进行讨论。     

血胆红素增高与老年人慢性硬脑膜下血肿

一、材料与方法1.一般资料 :本组共 40例 ,其中男性 2 8例 ,女性 12例 ,平均年龄6 7 2岁。2 .血肿部位及血肿量与胆红素的对应关系 :40例病人中有 34例血肿位于硬膜下 ,其中 2 2例血胆红素增高 ,6例硬膜外血肿病人无一例增高 ,2例合并有脑内血肿 ,急性血肿8例 ,慢性血肿 32例 ,血肿量最少40ｍｌ,最大 12 0ｍｌ,血总胆红素测定在入院后 2 4小时内 (正常值 1 7～17 0 μｍｏｌ) ,随机分为 3组 :(1) 4 0～6 0ｍｌ者 2 5例 ,血总胆红素为 17 0～2 5 μｍｏｌ的 12例。 (2 ) 6 1～ 80ｍｌ者 10例 ,血总胆红素位于 2 5～ 30 μｍｏｌ之间的 5例。 …     

机化型慢性硬脑膜下血肿1例

1临床资料患者,男,74岁,于四个月前左头顶部不慎撞于门框上,当时无明显不适,近一周感头晕,行走时不稳,向右侧摔跤次数多。查体:右侧上下肢肌力下降。入院时头颅MRI示左额颞枕部梭形改变,T1像高密度影,T2像低密度影。起初在局麻下行左顶钻颅,抽出褐色液体约5ml,术中见硬脑膜增厚,挑开硬脑膜困难,质韧。后改全麻下插管行左顶枕部骨瓣开颅,见血肿腔内黄褐色粪土样物质充盈,约80ml,予以清除。取其部分送病理检查,报告:血肿包膜纤维肉芽组织含铁血黄素及钙盐沉积。术后症状缓解,治愈出院,一月后头颅CT复查示脑复张好。2讨论机化型慢性硬脑膜下…     

Chronic subdural hematoma in utero

A case of chronic subdural hematoma and hydrocephalus diagnosed in utero is presented. No history of trauma could be elicited. Laboratory investigations failed to show a coagulation disorder. Both the hematoma and hydrocephalus were surgically treated 8 days after delivery. At 14 months of age the child is showing moderately delayed development. The literature is reviewed and discussed. The importance of correct antenatal diagnosis is stressed.     

Chronic subdural hematoma preceded by traumatic subdural hygroma

Patients with traumatic subdural hygroma (SDG) are at an increased risk of developing chronic subdural hematoma (CSDH). However, the mechanism by which this occurs is still not fully understood. The purpose of this paper is to investigate the clinical characteristics and pathogenesis of CSDH, as well as the relationship between CSDH and SDG. We review the pertinent literature and retrospectively examine a series of cases in which CSDH had been preceded by SDG to understand the natural history and developmental mechanisms of these lesions. We discuss the cases of 24 patients in whom CSDH developed from traumatic SDG between 2001 and 2005. Headache was the most common symptom, and the mean Glasgow Coma Scale score was 14.1. Increases in SDG volume were observed in CT scans of 17 patients, and increased density and volume was observed in five patients. The mean interval between the two diseases was 57.6 days, and 13 patients developed new symptoms after the development of CSDH. The most common symptoms at that time were headache and hemiparesis. All patients underwent an operation, which resulted in good recovery in all but one case. The cycle of persistent SDG, rebleeding, coagulation and fibrinolysis contributes to the development of CSDH from SDG. It is important to understand the natural history of CSDH and carefully follow up patients with head injury, especially if it is associated with SDG, and the potential for the development of CSDH should be considered.     

Chronic subdural hematoma: Reliability of radioisotope imaging versus computed tomography

25 surgically verified cases of chronic subdural hematoma (CSH) were examined retrospectively. All the patients had been investigated both with computed tomography (CT) and with radioisotope imaging (RI). RI supplied a correct diagnosis in all cases whilst CT yielded a doubtful diagnosis (generic signs of spaceoccupying lesion) in 5 cases and normal findings (false negative) in one. The clinical use of the two investigations is discussed. The study shows the reliability of RI in the diagnosis of CSH especially when CT determines the site but not the nature of the lesion (hematoma in the isodense phase).

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Sommario Sono stati esaminati retrospettivamente 25 casi di ESC (Ematoma Subdurale Cronico) verificati chirurgicamente. Tutti i pazienti erano stati sottoposti sia a TC (Tomografia Computerizzata) che ad ER (Esame Radioisotopico). L'ER ha permesso diformulare la diagnosi esatta in tutti i casi mentre la TC ha fornito in 5 casi una diagnosi dubbia (segni generici di processo espansivo) ed in un caso è risultato normale (falso negativo). Viene discusso l'uso clinico dei due esami. Lo studio dimostra la affidabilità dell'ER nella diagnosi di ESC in particolare quando la TC permette solo una diagnosi di presenza ma non di natura della lesione (ematoma in fase di isodensità).

     

慢性硬膜下血肿术后早发性癫痫的影响因素

目的 探讨钻孔引流治疗慢性硬膜下血肿术后早发性癫痫的影响因素。方法 分析2011年1月—2020年1月在龙岩市第二医院和嘉兴市第一医院采用钻孔引流治疗的230例慢性硬膜下血肿患者的临床资料,分析性别、血肿量、血肿厚度、单双侧出血、术前MGS-GCS评分、电解质异常、术后24 h血肿清除率、术后是否颅内积气和是否使用预防性抗癫痫药物与术后早发性癫痫的相关性。结果 230例患者中术后13例发生早发性癫痫,术后早发性癫痫的发生率为5.7%。多因素Logistic回归分析显示术后24 h血肿清除率≥60%（95%CI：1.009~1.092）、未使用预防性抗癫痫药物（95%CI：0.033~0.575）和颅内积气（95%CI：2.113~26.744）与早发性癫痫相关（P＜0.05）。结论 钻孔引流治疗慢性硬膜下血肿术后早发性癫痫的发生与术后24 h血肿清除率和颅内积气相关,预防性使用抗癫痫药物能预防早发性癫痫。 [国际神经病学神经外科学杂志, 2022, 49(3): 21-25.]     

Infantile acute subdural hematoma

A retrospective analysis of the infantile acute subdural hematoma was made with special reference to its pathogenesis. In 11 of 15 cases, the hematomas were bilateral or a contralateral subdural fluid collection was present. In 7 of 11 patients who underwent operation the collection was bloody fluid and/or clotted blood. In 3 patients, a subdural membrane, as seen in adult chronic subdural hematoma, was found. In only 1 patient with unilateral hematoma was clotted blood present without subdural membrane. The thickest collection of clotted blood was in the parasagittal region. It is postulated that in most cases hemorrhage occurs after minor head injury, from the bridging veins near the superior sagittal sinus, into a pre-existing subdural fluid collection such as chronic subdural hematoma or subdural effusion with craniocerebral disproportion, and that infants without intracranial disproportion are unlikely to have acute subdural hematoma caused by minor head injury.     

慢性硬膜下血肿合并急性脑梗塞

目的 探讨慢性硬膜下血肿合并急性脑梗塞的病因、预防与诊断治疗。方法 总结慢性硬膜下血肿合并急性脑梗塞22例，结合献分析。结果 慢性硬膜下血肿合并同侧大面积脑梗塞3例，基底节区梗塞11例，其他脑梗塞8例，其中慢性硬膜下血肿术后脑梗塞12例。结论 血容量不足、凝血机制障碍、脑灌注压降低、血管痉挛、脑动脉硬化与心脏疾病是慢性硬膜下血肿合并急性脑梗塞的原因。血肿钻孔引流、纠正血容量、扩容、解痉、脱水、降颅压、神经保护和抗血小板聚集是其有效治疗手段。     

Lumbosacral spinal subdural hematoma following burr hole craniotomy: case report and literature review

Spinal subdural hematoma is a rare complication of cranial surgery. This study reports a case of postcraniotomy lumbosacral spinal subdural hematoma in the absence of predisposing factors. A review of the literature is also presented.     

Idiopathic chronic subdural hematoma in the newborn: case report

Background Evidence of intrauterine development of chronic subdural hematoma (CSH) is extremely rare. A very limited number of cases with known and acceptable etiological explanation are reported. We were able to find out only four presented cases of intrauterine development of CSH without known etiology.Case report We present our case with a newborn baby with CSH without known etiology. Short literature review and possible etiological factors are observed.     

慢性硬膜下血肿脂联素和基底膜蛋白多糖的表达

目的 探讨慢性硬膜下血肿脂联素(APN)、基底膜蛋白多糖(PL)的表达变化.方法 2019年5月至2020年5月钻孔引流术治疗CSDH共32例,所有病人入院后均服用阿托伐他汀钙片,直至复查CT示血肿完全吸收.术前、术后3 d、术后3周各取静脉血5 ml,术中采集血肿液5 ml,采用酶联免疫吸附法检测APN和PL的浓度....     

慢性硬脑膜下血肿的血肿成份分析及发病机理研究

作者对65例慢性硬膜下血肿病人的血肿成份进行分析,以探讨该病的发病机理及治疗问题。血肿成份的分析证实活体病人血肿液的血红蛋白及红细胞含量与血肿的CT值是显著性正相关,血肿液的血红蛋白与红细胞含量与病人的病程无显著相关性。对血肿性状的分析提示采用颅骨钻孔引流术可有效地清除血肿。本组观察结果支持该病的发病机理与原发血肿外膜持续出血致血肿扩大有关的理论。