两种硬膜下引流方式治疗慢性硬膜下血肿的疗效分析

目的比较颅骨钻孔T管引流术和常规硬膜下引流术治疗慢性硬膜下血肿(CSDH)的临床治疗效果,为临床手术方式的选择提供参考。方法回顾性分析2011-12-2018-12驻马店市第一人民医院神经外科收治的108例CSDH患者的临床资料,按引流方法分为T管引流组和常规硬膜下引流组,并对相关变量进行统计学分析。结果 2组手术时间、住院时间、术后3个月Markwalder神经功能分级方面无显著性差异(P0.05)。T管引流组术后并发症发生率和血肿复发率均低于常规硬膜下引流组(P0.05)。结论两种手术方法均取得了较好的治疗效果,但T管引流术总体术后并发症发生率和血肿复发率均低于常规硬膜下引术,表明颅骨钻孔T管引流术可能是治疗CSDH更好的手术选择。     

症状性慢性硬膜下血肿钻孔置管骨膜下引流的临床疗效观察

目的探讨钻孔冲洗骨膜下置管持续引流治疗症状性慢性硬膜下血肿的疗。方法选取我院收住的有明显神经功能缺失的单侧慢性硬膜下血肿患者40例,行钻孔术后,采用随机数字表法以及随机数余数分组法随机分为骨膜下持续引流治疗组20例,硬膜下持续引流组20例,两组术后均常规药物治疗。计算各组患者术前及术后血肿量变化以及术后硬膜下血肿复发、并发症发生及术后引流量情况,并比较两种引流方法治疗效果的差异。结果两组术后血肿量变化差异无统计学意义(P=0.619,0.639),但术后同侧颅内硬膜下血肿复发率以及术后癫痫发生率,骨膜下引流组低于硬膜下引流组(P=0.005,0.007)。而且,两组患者术后24小时内引流量比较,骨膜下引流治疗组较硬膜下引流组更为彻底,差异有统计学意义(P=0.000);两组术后24~48小时内引流量及术后48小时内引流量比较,硬膜下引流组会导致过度引流,差异有统计学意义(P=0.000,0.000)。结论颅骨钻孔置管骨膜下引流治疗慢性硬膜下血肿与硬膜下引流比较,慢性硬膜下血肿清除效果无明显区别,但更有利于减少术后血肿复发及术后并发症的发生,原因为骨膜下引流可以规避手术对蛛网膜的二次损伤,手术过程更安全,值得一些基层医疗单位推广应用。     

颅骨钻孔T管引流治疗慢性硬脑膜下血肿的体会

慢性硬脑膜下血肿(chronic subdural hematoma,CSDH)是神经外科的常见病,好发于50岁以上的老年人,可无明确的或仅有轻微的头部外伤史,以慢性颅内压增高症状为主,治疗首选颅骨钻孔冲洗引流术,但术后颅内积气、血肿残留、硬膜下积液和术后复发是目前常见问题.我科自2006年1月至2010年12月共收治58例慢性硬脑膜下血肿患者,采用颅骨钻孔改良T管引流治疗,取得良好的效果.现将其临床资料、治疗方法及效果报告如下.     

单孔引流合并引流后鞘内灌注生理盐水治疗单房慢性硬膜下血肿体会

目的探讨单房慢性硬膜下血肿的治疗方法及效果。方法我院2001年1月至2010年1月共收治82例单房慢性硬膜下血肿患者,其中单侧72例,双侧10例,均采用单孔引流合并引流后鞘内灌注生理盐水治疗。结果 82例全部治愈,7例术后出现并发症,经处理后好转,无死亡病例。结论单房慢性硬膜下血肿采用单孔引流合并鞘内灌注生理盐水治疗,效果良好,并发症明显减少。     

慢性硬膜下血肿钻孔引流术并发症及其防治体会

目的探讨慢性硬膜下血肿术钻孔引流后并发症发生的原因及防治措施，以减少误诊或漏诊，提高疗效。方法我科2000年1月至2007年1月共收治108例慢性硬膜下血肿患者，其中双孔引流30例，单孔冲洗引流75例，去骨瓣减压清除血肿及包膜切除术3例。结果108例中96例恢复良好，12例伴发并发症，经对症治疗后均好转。结论目前，颅骨钻孔引流冲洗引流术是治疗有症状的慢性硬膜下血肿的首选方法，防治术后并发症是治疗关键。     

两种手术方法治疗慢性硬膜下血肿伴急性出血的效果分析

目的分析采用开颅清除血肿与钻孔术腔冲洗持续引流治疗慢性硬膜下血肿伴急性出血的临床疗效。方法回顾性分析西南医科大学附属医院神经外科2008年5月至2017年8月收治的47例慢性硬膜下血肿伴急性出血患者的临床及随访资料,23例采用开颅清除血肿(开颅组),24例采用钻孔术腔冲洗持续引流(钻孔组)。比较两组术后置管时间、住院时间、术后1个月残余血肿量、3个月复发例数,并分析其临床效果。结果 3例患者失访,其中开颅组2例,钻孔组1例。开颅组置管时间1.9±0.7天,住院日10.8±1.3天,术后1月血肿残余2.0±0.5ml,复发0例。钻孔组置管时间5.5±0.9天,住院日11.2±1.2天,术后1月血肿残余13.4±1.8ml,复发3例;两组住院时间无统计学意义(P0.05),置管时间、术后1月血肿残余量、复发率有统计学意义(P0.05)。结论对慢性硬膜下血肿伴急性出血患者,行开颅清除血肿较钻孔术腔冲洗持续引流具有置管时间短、术后1月血肿残余少、复发率低等优点。     

双腔管冲洗引流治疗慢性硬膜下血肿120例

目的探讨双腔管冲洗引流治疗慢性硬膜下血肿的效果。方法根据CT定位，采用双腔硅胶引流管生理盐水冲洗引流治疗慢性硬膜下血肿120例。结果本组病例术后1-4h症状均明显改善，术后7～10d痊愈出院，无死亡病例，无并发症。术后1～3月复查CT示无1例复发，全部恢复正常生活和工作。结论钻孔引流术是治疗慢性硬膜下血肿的首选方法，而双腔管冲洗引流术治疗慢性硬膜下血肿方法简单，并有效避免了钻孔引流术的相关并发症，且效果满意，可广泛开展。     

颅骨钻孔T管挂壁引流术治疗慢性硬膜下血肿的疗效观察

目的 探讨颅骨钻孔T管挂壁引流术治疗慢性硬膜下血肿的疗效。方法 回顾性分析2012年1月至2017年6月采用颅骨钻孔T管挂壁引流术治疗的58例慢性硬膜下血肿的临床资料。结果 58例均顺利清除血肿。术后24~48 h复查头颅CT,同侧硬膜下积液（术中冲洗液）30例,同侧硬膜下少量积气8例,原血肿腔少量血肿残留10例。术后随访3~6个月,原硬膜下积液、积气、残留血肿完全吸收;2例复发,再次手术后好转。所有临床症状均明显改善、消失。结论 颅骨钻孔T管挂壁引流术治疗慢性硬膜下血肿,有效且简单易行,术后并发症少。     

分隔型慢性硬膜下血肿的手术治疗

目的 比较两种手术方法治疗分隔型慢性硬膜下血肿的疗效。方法 回顾性分析2016年1月至2021年1月收治的85例分隔型慢性硬膜下血肿的临床资料。结果 45例采用神经内镜手术治疗（内镜组）,40例采用钻孔引流术治疗（引流组）。与引流组相比,内镜组手术时间、术中失血量明显增加（P<0.05）,但是术后6 h血肿清除率明显提高（P<0.05）,引流管留置时间和住院时间明显缩短（P<0.05）,术后硬膜下积气发生率、颅内感染发生率、血肿复发率均明显降低（P<0.05）;术后6个月Bender分级明显改善（P<0.05）。结论 两种手术方法治疗分隔型慢性硬膜下血肿,各有利弊。神经内镜手术具有血肿清除率高、副损伤小、并发症低、复发率低、预后良好的优点。     

锥颅双孔置管尿激酶引流治疗老年人慢性硬膜下血肿

目的 探讨锥颅双孔置管尿激酶溶解引流术治疗老年人慢性硬膜下血肿的效果。方法 2000年2月至2006年4月我科对52例老年慢性硬膜下血肿病人采用经皮颅内血肿前上部和后下部锥颅置管、注入尿激酶液化血肿，辅以促进受压脑组织复位等措施。术后观察受压脑组织复位时间、引流时间、Barthel指数评分、CT复查结果。结果 本组52例术后血肿清除或基本清除。受压脑组织复位时间、引流时间、Barthel指数评分及CT复查结果显示，病人预后良好，无复发。结论 锥颅双孔置管尿激酶引流治疗老年人慢性硬膜下血肿，操作方法简单，时间短，创伤小，不易感染，能较彻底地清除血肿，疗效满意，复发率低。     

Calcified chronic subdural hematoma mimicking calvarial mass: a case report

Head trauma is a frequent cause of mortality and morbidity in the pediatric population. Chronic subdural hematoma is the most common traumatic lesion in head injury. Chronic subdural hematomas are rare in children older than 2 years old; they are more frequent during adolescence. Calcified or ossified chronic subdural hematoma is a rare entity that usually presents as a space-occupying lesion over the cerebral convexity. Chronic calcified subdural hematomas are reported less than chronic subdural hematomas. In this article, we report a successfully treated patient with surgical removal case of calcified chronic subdural hematoma mimicking calvarial mass.     

Complications of the chronic subdural hematoma.

Eighty three chronic subdural hematomas, obtained by surgery or by necropsy, were examinated. The patient age distribution curve of the non-complicated operative cases showed the highest incidence in the first year of life and also a moderate increase in the elderly group. Recurrent hemorrhage in the walls and in the cavity, was observed in twenty of the seventy three non-complicated cases of chronic subdural hematoma. In five cases the membranes and the subdural sac were invaded by leucemic cells and in the five remaining ones the hematoma was transformed in a subdural empyema. All these complicated subdural hematomas showed evidence of recurrent bleeding, suggesting that the leucemic cells or the infectious agent had spread to the subdural space by this way.     

The relationship between coagulation time and bilateral occurrence in chronic subdural hematoma]

The relationship between the bilateral occurrence and coagulation time was analyzed in 137 cases of chronic subdural hematoma. Bilateral chronic subdural hematomas more frequently happened in the patient with coagulation time elongation beyond the normal control. This tendency was significant in the non-traumatic group and bilateral subdural hematomas were found in: 45% in prothrombin time (PT)-elongated group vs 10.3% in non-elongated group and 38.9% in activated partial thromboplastin time (aPTT)-elongated group vs 14.6% in non-elongated group. The ratio of PT and aPTT coagulation time against the normal control was significantly larger in the bilateral group than in the unilateral group. The ratio was as follows: PT ratio was 1.056 in bilateral group and 0.995 in unilateral group. aPTT ratio was 1.051 in bilateral group and 0.954 in unilateral group. Furthermore the bilateral hematomas tended to happen in hemodialysis cases, and in patients on warfarin or anti-platelet drugs. Bilateral hematomas were found in 41.7%, 37.5% and 33.3% respectively. The ratio of PT and aPTT coagulation time was as follows: PT ratio was 1.040 in hemodialysis cases and 1.082 in warfarin-applicated cases. aPTT ratio was 1.022 in hemodialysis cases and 1.055 in warfarin-applicated cases. These results suggest that the suppressed coagulation ability and platelet function are involved in the genesis of bilateral chronic subdural hematomas.     

Y-型双腔引流管+持续灌注与单腔引流管单纯引流治疗老年亚急性硬膜下血肿的疗效比较

目的比较Y-型双腔引流管+持续灌注与单腔引流管单纯引流治疗老年亚急性硬膜下血肿的疗效。方法将2013年1月至2015年12月期间收治的28例接受手术治疗的亚急性硬膜下血肿老年患者,随机分为Y-型双腔引流管+持续灌注组与单腔引流管单纯引流组,其中Y-型双腔引流管+持续灌注组17例,单腔引流管单纯引流组11例。比较2组术后1 d,2 d,3 d,14 d,3个月OM线上第5层面的中线偏移值。并比较两组引流液恢复正常所需时间及复发率。结果 Y-型双腔引流管+持续灌注组与单腔引流管单纯引流组中线偏移距离术前无显著性差异,术后1 d两组中线偏移距离仍无显著性差异,但术后2 d,3 d,14 d,3个月中线偏移距离存在显著性差异。治疗组引流液清亮需要的中位时间为2 d,无1例复发。对照组引流液清亮需要中位时间为3 d,2例复发,差异有统计学意义(P0.05)。结论 Y-型双腔引流管+持续灌注治疗亚急性硬膜下血肿安全可靠,方法简便易行。     

Computed tomography of extracerebral hematoma.

The appearance on C.T. of 30 extracerebral hematomas is described. Acute subdural hematomas were seen as bandlike lesions with markedly increased, homogenous density. Epidural hematomas demonstrated a high density and a biconvex, lenticular shape. During the process of liquefaction the density decreases and three hematomas appeared as isodense lesions. The majority of chronic subdural hematomas presented a mildly to moderately decreased, nonhomogenous density, the clearly identifiable inner wall of the lesion being either convex or concave. Subdural hygromas showed a homogeneous, markedly decreased density. Almost all the hematomas caused compression of the homolateral lateral ventricle and displacement of midline structures, particularly of the septum pellucidum. In 60% of the hematomas a dilatation of the contralateral lateral ventricle, predominantly of the posterior part was seen. Acute hematomas presented oedema in varying degrees, in chronic hematomas oedema was usually absent. In the original interpretation extracerebral hematomas were recognized as a lesion on C.T. in 97% (1 false negative result), in 90%, the lesion was correctly diagnosed as an extracerebral hematoma (1 false negative and 2 incorrect). The series contained one false positive C.T. scan and 2 intracerebral hematomas were interpreted incorrectly as subdural hematomas. The review C.T. diagnosis proved to be correct in 100%. C.T. and angiography appeared to have about the same diagnostic accuracy. However, C.T. is a non invasive investigation and it provides valuable additional information with regard to all the intracranial contents. Therefore C.T. should be the method of first choice in the diagnosis of extracerebral hematomas.     

Computed tomography of extracerebral hematoma

The appearance on C.T. of 30 extracerebral hematomas is described. Acute subdural hematomas were seen as bandlike lesions with markedly increased, homogeneous density. Epidural hematomas demonstrated a high density and a biconvex, lenticular shape. During the process of liquefaction the density decreases and three hematomas appeared as isodense lesions. The majority of chronic subdural hematomas presented a mildly to moderately decreased, nonhomogeneous density, the clearly identifiable inner wall of the lesion being either convex or concave. Subdural hygromas showed a homogeneous, markedly decreased density.

Almost all the hematomas caused compression of the homolateral lateral ventricle and displacement of midline structures, particularly of the septum pellucidum. In 60% of the hematomas a dilatation of the contralateral lateral ventricle, predominantly of the posterior part was seen. Acute hematomas presented oedema in varying degrees, in chronic hematomas oedema was usually absent.

In the original interpretation extracerebral hematomas were recognized as a lesion on C.T. in 97% (1 false negative result), in 90%, the lesion was correctly diagnosed as an extracerebral hematoma (1 false negative and 2 incorrect). The series contained one false positive C.T. scan and 2 intracerebral hematomas were interpreted incorrectly as subdural hematomas. The review C.T. diagnosis proved to be correct in 100%.

C.T. and angiography appeared to have about the same diagnostic accuracy. However, C.T. is a non invasive investigation and it provides valuable additional information with regard to all the intracranial contents. Therefore C.T. should be the method of first choice in the diagnosis of extracerebral hematomas.     

Intrauterine chronic subdural hematoma with postoperative tension pneumocephalus

A newborn infant demonstrated prenatal, bilateral chronic subdural hematomas with recent hemorrhage, internal hydrocephalus, and macrocephaly at birth. Serial cranial ultrasound and computed tomography evaluations revealed progressive hydrocephalus and subdural hematomas. Following surgical evacuation of subdural hematomas the child developed tension pneumocephalus with clinical deterioration. The pathogenesis of congenital subdural hematoma and rare postoperative complication of tension pneumocephalus are discussed.     

Reversible parkinsonism due to chronic bilateral subdural hematomas

Subdural hematoma is a rare cause of secondary parkinsonism. We report a 65-year-old woman with reversible parkinsonism due to bilateral chronic subdural hematomas. Symmetrical parkinsonism evolved acutely 45 days after a trivial head injury. Mild pyramidal signs were also present on her left side. MRI revealed bilateral chronic subdural hematomas. The patient’s parkinsonism was completely abolished one month after successful neurosurgical evacuation of the hematomas.     

Irrigation vs. closed drainage in the treatment of chronic subdural hematoma.

A number of different techniques are used to treat chronic subdural hematomas surgically. In this study, 70 chronic subdural hematomas were surgically treated and analyzed prospectively. Patients were classified according to clinical features and computed tomography images. Results of the cases that underwent burr-hole craniostomy-irrigation (group A; n=35) were compared with those undergoing burr-hole craniostomy-closed system drainage (group B; n=35). The most common etiological factor was trauma in both groups. Complete resolution in the early period was higher in group B compared to group A (60% vs. 40%). However, no difference was noted at the first month-follow-up. Recurrence rates were 17% in group A and 14% in group B. No significant difference was noted in terms of hospitalization duration or postoperative complications. In conclusion, we believe that the burr-hole craniostomy-irrigation technique is a reliable and effective method compared to burr-hole craniostomy-closed system drainage in the treatment of chronic subdural hematoma.     

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.