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。     

改进法闭式引流治疗慢性硬膜下血肿的疗效分析

 目的 比较改进慢性硬膜下血肿闭式引流手术方法与常规闭式引流手术方法的效果.方法 回顾性分析18例改进法闭式引流术后1 d和22例常规闭式引流术后3～4 d慢性硬膜下血肿患者的头颅CT扫描以及两组术后10 d头颅CT扫描,测量两组患者血肿腔内残留气体和液体量并进行统计学分析.结果 改进法闭式引流组仅有微量气体和液体残留,而常规法闭式引流组则有较多气体和液体残留,两组血肿腔积气和液体残留量比较有显著统计学意义(P<0.001).结论 改进法闭式引流手术是治疗慢性硬膜下血肿的更好的方法,符合生理,引流彻底,手术效果好.     

MRI depiction of chronic intradural (subdural) hematoma in evolution

The usual chronic subdural hematoma encountered in the elderly is actually thought to be a chronic intradural hematoma, which has been described clinically and anatomically. However, the evolution of how this chronic hematoma occurs remains enigmatic. We report the first magnetic resonance (MR) depiction of an apparent chronic intradural hematoma in evolution over several months in a 61-year-old man after a minimal head injury. The time delay from injury, subsequent focal pachymeningeal T1-gadolinium enhancement, and apparent splitting of the pachymeninges by proven chronic hematoma should serve as a stimulus for further MR investigations of this interesting process.     

两种不同术式治疗慢性硬脑膜下血肿的临床分析

目的探讨慢性硬膜下血肿（CSDH）的发病机制、临床特点和治疗方法。方法回顾性分析20年间前后两个阶段诊治的慢性硬脑膜下血肿316例，并从临床特点、影像学资料、预后、并发症以及两种手术疗效进行比较。结果87．3％的患者恢复良好，10．7％无改变或加重，病死率为1．9％。细孔钻孔＋密闭式硬通道引流与颅骨钻孔＋软管引流相比，术后并发症减少，再手术率低。结论细孔钻孔＋密闭式硬通道引流手术，操作简单，用时短，安全有效，适合各年龄组，值得推广。     

锥孔与钻孔引流手术治疗慢性硬脑膜下血肿的临床应用比较

目的对慢性硬脑膜下血肿的锥孔引流和传统钻孔引流术疗效进行回顾性比较,以明确两种手术方法的优缺点,找出治疗慢性硬脑膜下血肿的最佳方法。方法锥孔组86例患者采用床边直接锥孔冲洗引流,钻孔组82例患者采用传统钻孔引流术。两组患者术后2～3 d复查头颅CT,对手术时间、术后并发症、症状改善、平均住院日、痊愈率及复发情况进行对比研究。结果两组患者均痊愈。两组患者住院期间主诉改善、术后继发血肿及复发情况等比较,差异无统计学意义(P>0.05)。锥孔组平均手术时间(35±5)min,少于钻孔组的(60±8)min;锥孔组平均住院日(6.5±0.5)d,少于钻孔组的(10.5±1.0)d;锥孔组颅内积气发生率明显少于钻孔组,两组对比差异均有统计学意义(P<0.05)。结论锥孔引流手术有创伤小、操作简便、手术时间及平均住院日短等优点。     

两种不同术式治疗慢性硬脑膜下血肿的临床分析

目的 探讨慢性硬膜下血肿(CSDH)的发病机制、临床特点和治疗方法.方法 回顾性分析20年间前后两个阶段诊治的慢性硬脑膜下血肿316例,并从临床特点、影像学资料、预后、并发症以及两种手术疗效进行比较.结果 87.3%的患者恢复良好,10.7%无改变或加重,病死率为1.9% .细孔钻孔 密闭式硬通道引流与颅骨钻孔 软管引流相比,术后并发症减少,再手术率低.结论 细孔钻孔 密闭式硬通道引流手术,操作简单,用时短,安全有效,适合各年龄组,值得推广.     

微创软通道对慢性硬膜下血肿的治疗

目的探讨慢性硬膜下血肿的简便、安全、有效的临床治疗方法。方法选择慢性硬膜下血肿的病人,随机分为传统外科手术组(对照组)和微创治疗组,对照组采用传统的外科手术治疗,微创治疗组采用简易脑立体定向微创软通道技术。结果两组治疗效果、复发率异差无统计学意义(P>0.05),两组的平均住院时间比较差异有统计学意义(P<0.05),外科手术治疗组平均住院时间高于微创治疗组。结论慢性硬膜下血肿实施定向微创软通道手术,较对照组,可减轻患者手术痛苦、扩大手术实施的人群范围,减少患者平均住院天数,治疗效果与传统外科手术治疗,无显著差异。     

慢性硬膜下血肿86例手术治疗分析

目的总结手术治疗慢性硬膜下血肿的经验。方法回顾性分析我科2004年1月—2012年9月86例慢性硬膜下血肿患者采用手术治疗的临床资料,其中83例,采用进一步改进的钻单孔引流法;3例采用内镜微创治疗。结果 86例患者术后3 d内症状有不同程度好转,随访3个月,血肿消失,无复发。结论针对不同类型的慢性硬膜下血肿,分别采用改进后的钻单孔引流法和内镜微创手术,疗效满意。     

Chronic subdural hematomas

Summary Surgery was undertaken on 32 chronic subdural hematomas in a series of 28 patients who had preoperatively undergone delayed contrast-enhanced computed tomography (DCECT). Timedensity curves on DCECT and iodine concentrations of subdural specimens revealed that chronic subdural hematomas, regardless of density, were significantly enhanced by the entrance of intravascular contrast medium into the interior of hematomas. The ingress of intravascular contrast medium into the interior of the hematomas was chemically proven and might result from a complex transcapillary shift.     

老年患者慢性硬脑膜下血肿的手术处理及神经康复治疗

目的；分析总结83例老年患者慢性硬膜下血肿（chronic subdural hematoma,CSH）的处理及神经康复治疗经验。方法：本组83例CSH均经头颅扫描确诊，且均行钻孔引流术，并给予神经康复治疗和指导。结果：按GOS评分，优良79例（95．18％），中残4例（4．82％）。结论：对老年CSH进行及时诊断和手术，加强神经康复治疗和指导能够明显提高其疗效。     

Spinal subdural hematoma

 We report the case of a 68-year-old patient with a traumatic spinal subdural hematoma. MRI demonstrated an area of abnormal intensity and a black line in the inner part of the intradural space. We anti-cipate that MRI will help to make one more confident in the preoper-ative diagnosis of spinal subdural hematoma. The symptoms complet-ely disappeared immediately after the operation. Spinal subdural he-matoma requires immediate surgical evacuation. The prognosis for func-tional recovery is good if the condi-tion is appropriately diagnosed and treated before development of irre-versible paralysis. We recom-mend MRI to make an early diagnos-is and early evacuation of spinal subdural hematoma.     

创伤性双侧慢性硬膜下血肿的C特征及危险因素

目的探讨创伤性双侧慢性硬膜下血肿（BCSDH）的CT特征及危险因素。方法回顾有随访资料的创伤性慢性硬膜下血肿（CSDH）52例。先研究其CT表现,然后采用多因素Logistic回归分析从以下变量中,如年龄、性别、伤后“潜伏”时间、受伤着力部位、受伤时有无昏迷经过、伤时CT表现等确定BCSDH发生的影响因素。结果在52例创伤性慢性硬膜下血肿中,BCSDH（23例）占44．2％。BCSDH除具有单侧CSDH的cT特征外,尚具有自身的一些特点。在多因素Logistic回归分析中,与双侧血肿发生显著相关的因素为年龄,当年龄〉70岁时,双侧血肿发生的危险度大。结论对于高龄患者,应警惕BCSDH的发生。为此,仔细研究其CT特点是必须的。     

外侧裂区急性硬膜下血肿的临床分析

目的 探讨外侧裂区急性硬膜下血肿的治疗方法。方法 对46例患者进行回顾性分析,全部病例入院后即行头颅CT检查,其中44例行手术治疗。结果 本组外侧裂区急性硬膜下血肿主要是因脑挫裂伤,皮层血管破裂出血所致,手术是其主要治疗手段。本组死亡15例,重残3例,轻残8例。结论 外侧裂区急性硬膜下血肿死亡率较高,应尽快明确诊断,及时手术,手术宜采取大骨瓣开颅。术后可给予活血药物以改善脑缺血缺氧。     

Revisiting the canonical definition of heat hematoma: A rare case of postmortem subdural heat hematoma

Heat hematoma is generally recognized as a postmortem heat-induced artifact in extradural spaces found in burned bodies. Conversely, subdural hematoma in charred bodies is more indicative of antemortem trauma. Here, we present a rare case of a subdural heat hematoma in forensic practice. The subdural hematoma was found in a charred body that was determined to be dead before the fire without findings of antemortem head injury. Furthermore, the detailed determination and formation mechanism of this subdural heat hematoma are discussed. With this rare case, we propose a reconsideration of the canonical definition of heat hematoma. This report envisions benefitting forensic pathologists facing similar cases.     

颅脑损伤后急性硬膜下血肿预后相关因素的探讨

目的探讨影响急性硬膜下血肿(ASDH)预后的相关因素。方法回顾性总结我院2000年3月～2009年3月256例ASDH手术治疗患者术前及术后1个月临床资料,通过Logistic回归分析评价影响患者预后的相关危险因素。结果术后神经功能恢复良好42.2%,主要影响因素为:年龄、术前瞳孔变化、术前格拉斯哥评分(GCS)、术中脑肿胀;死亡率39.8%,主要影响因素为:术前瞳孔变化、术前GCS评分、术中脑肿胀、术前低血压和低氧血症。而术前头颅CT中线偏移程度、血肿量及血肿厚度、伤后手术时间与术后预后有关,但不是主要影响因素。结论急性硬膜下血肿患者年龄40岁、术前GCS评分较高、术前瞳孔光反射存在、术前无低血压和低氧血症、无脑肿胀,患者功能恢复相对较好。     

MRI findings in spinal subdural and epidural hematomas

BACKGROUND: Spinal hematomas are rare entities that can be the cause of an acute spinal cord compression syndrome. Therefore, an early diagnosis is of great importance. PATIENTS AND METHODS: From 2001 to 2005 seven patients with intense back pain and/or acute progressive neurological deficit were studied via 1.5 T MRI (in axial and sagittal T1- and T2-weighted sequences). Follow-up MRI was obtained in six patients. RESULTS: Four patients showed the MRI features of a hyperacute spinal hematoma (two spinal subdural hematoma [SSH] and two spinal epidural hematoma [SEH]), isointense to the spinal cord on T1- and hyperintense on T2-weighted sequences. One patient had an early subacute SEH manifest as heterogeneous signal intensity with areas of high signal intensity on T1- and T2-weighted images. Another patient had a late subacute SSH with high signal intensity on T1- and T2-weighted sequences. The final patient had a SEH in the late chronic phase being hypointense on T1- and T2-weighted sequences. DISCUSSION: MRI is valuable in diagnosing the presence, location and extent of spinal hematomas. Hyperacute spinal hematoma and the differentiation between SSH and SEH are particular diagnostic challenges. In addition, MRI is an important tool in the follow-up in patients with conservative treatment.     

Neonatal infratentorial subdural hematoma contributing to obstructive hydrocephalus in the setting of therapeutic cooling: A case report

BACKGROUNDSymptomatic neonatal subdural hematomas usually result from head trauma incurred during vaginal delivery, most commonly during instrument assistance. Symptomatic subdural hematomas are rare in C-section deliveries that were not preceded by assisted delivery techniques. Although the literature is inconclusive, another possible cause of subdural hematomas is therapeutic hypothermia.CASE SUMMARYWe present a case of a term neonate who underwent therapeutic whole-body cooling for hypoxic ischemic encephalopathy following an emergent C-section delivery for prolonged decelerations. Head ultrasound on day of life 3 demonstrated a rounded mass in the posterior fossa. A follow-up brain magnetic resonance imaging confirmed hypoxic ischemic encephalopathy and clarified the subdural hematomas in the posterior fossa causing mass effect and obstructive hydrocephalus. CONCLUSIONThe aim of this report is to highlight the rarity and importance of mass-like subdural hematomas causing obstructive hydrocephalus, particularly in the setting of hypoxic ischemic encephalopathy and therapeutic whole-body cooling.     

Computed-tomography of bilateral isodense chronic subdural hematomas

Summary While unilateral chronic isodense subdural hematomas as a result of indirect signs of a space-occupying lesion are easily recognizable on computed tomography (CT) and clearly diagnosed on the angiogram, bilateral chronic isodense subdural hematomas may cause considerable difficulty. In two cases with CT false negative findings we observed, retrospectively, significant small cellae mediae and also the main part of the anterior horns sharply pointed and approaching one another. Three further cases showed the same ventricular configuration, which we called hare's ears sign. This sign together with clinical data is always suspicious of chronic bilateral isodense subdural hematomas and carotid angiography is indicated. Other possible signs are: subtle midline shift if the size of the hematoma varies, changed formation of density of brain tissue, non-appearance of cerebral sulci especially in elderly patients, and eventually the visualization of a membrane after intrevenous injection of contrast material.     

不同年龄慢性硬膜下血肿的临床特点

目的分析慢性硬膜下血肿（CSDH）患者各不同年龄组之间的临床特点。方法把2000～2009年间诊断为CSDH并经手术治疗的病例116例分成三组：即55岁以下组、55～75岁组和75岁以上组。对患者的一般资料、临床症状、影像学表现、治疗及预后等进行比较分析。结果①75岁以上组较前两组血小板计数数值小（P〈0.01）;②前两组患者与75岁以上组相比,出现头痛/头昏的比率高,出现精神异常/智力障碍及大小便失禁的比率低,后两组出现肢体瘫痪的比率高于55岁以下组（P〈0.01）;③55岁以下组患者头CT扫描以（稍）高或混杂密度和低密度为主,55～75岁组多为等密度,75岁以上多为低密度;55岁以下组患者血肿量要少于后两组（P〈0.05）;④术后绝大多数症状完全或部分缓解（93.10%）;75岁以上组6例（18.75%）效果不佳,其中2例（6.25%）死于心/肺功能衰竭。结论正确认识不同年龄组CSDH的临床特点,有利于提高该病的诊疗水平。     

Death due to delayed onset intracranial bleeding in a patient with an acute subdural hematoma

We report a fatal case of acute subdural hematoma (ASDH) involving the delayed onset of subdural bleeding after a head trauma. There were no central nervous symptoms after the head trauma and an initial head computed tomography (CT) scan did not exhibit any abnormal findings. On the second day, the patient suddenly complained of a headache and vomiting, and she lost consciousness. An emergency head CT scan detected a right-sided ASDH and severe cerebral herniation. As the patient was taking triple anticoagulant therapy, surgery could not be performed. She died 2 weeks after the onset of the ASDH. Even in cases of head trauma that do not exhibit abnormal findings on head CT, it is necessary to follow up the patient’s clinical condition. Specifically, controlling coagulability and performing repeated head CT examinations are considered to be beneficial for preventing abundant subdural bleeding and facilitating the early detection of delayed onset ASDH.