133例慢性硬膜下血肿患者的临床特点研究

目的：探究慢性硬膜下血肿（CSDH）病的临床特点。方法：133例CSDH患者,依据血肿的CT表现分为两组：双侧组（47例）和单侧组（86例）。对两组患者的临床表现、致病因素、CT表现、术后并发症及预后进行比较。结果：双侧CSDH组的恶心呕吐、头痛、步态不稳的症状显著多见于单侧CSDH组（P〈0.05）。双侧CSDH组的抗凝及抗血小板药物服用者显著多于单侧CSDH组（P〈0.05）。单侧CSDH组的中线移位（CT）发生率显著高于双侧CSDH组（P〈0.05）。结论：双侧CSDH常见于有抗凝及抗血小板药物服用史患者;双侧CSDH患者较单侧CSDH患者更易出现颅内压增高症状,而CT上较少出现明显的中线移位。     

双针穿刺治疗老年患者慢性硬膜下血肿

目的 总结30例经皮双针穿刺引流治疗老年患慢性硬膜下血肿效果，探讨慢性硬膜下血肿治疗方法。方法 本组30例慢性硬膜下血肿均经CT检查确诊，都行经皮双针穿刺引流术。结果 所有病例术后l～3d复查CT，血肿腔缩小90％以上，除10例有颅内积气外，未见颅内血肿、颅内感染、肺部感染和其它并发症。术后3～7d拔针，穿刺点一期愈合，痊愈出院，随访6-24月未见复发。结论 经皮双针穿刺引流治疗慢性硬膜下血肿是一种微创、简单、高效和并发症少的方法，但穿刺针需要作改进。     

Chronic subdural haematoma: surgical treatment and outcome in 1000 cases

Chronic subdural haematoma (CSDH) is one of the most common clinical entities in daily neurosurgical practice. To evaluate the clinical features, computed tomography findings, surgical results, and complications our series was statistically analysed to elucidate the factors affecting the post-operative outcome. A retrospective study (1980-2002) of the records of 1000 patients harbouring 1097 chronic subdural haematoma treated with burr-hole craniotomy with closed-system drainage was carried out. The series included 628 males and 372 females, age range 12-100 years, mean age 72.7+/-11.4 years. The mean interval from trauma to appearance of clinical symptoms was 49.1+/-7.4 days (15-751). The principal symptom was headache (29.7%) in the over 70s, and behavioural disturbance (33.8%) in the under 70s. The CSDH was right sided in 432 patients, left sided in 471, and bilateral in the remaining 97 cases. Post-operative complications occurred in 196 patients and 21 patients died in hospital. Poor prognosis was related to patient's age (>70) and clinical grade on admission (grades 0-2 versus grades 3-4).     

双侧慢性硬膜下血肿的手术治疗体会

目的探讨微创穿刺外引流术治疗双侧慢性硬膜下血肿的疗效及手术技巧。方法回顾分析自2011年9月至2013年7月共采用微创穿刺外引流术治疗双侧慢性硬膜下血肿12例,并对出院患者进行随访,总结治疗效果。结果 12例患者出院前7例血肿腔消失,5例存在少量硬膜下积液。结论双侧同时微创穿刺交替冲洗外引流术治疗双侧慢性硬膜下血肿,可以有效减轻术中、术后并发症,安全有效,值得推广。     

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.     

Relation between brain displacement and local cerebral blood flow in patients with chronic subdural haematoma

OBJECTIVES: To evaluate the relation between brain displacement, clinical signs and symptoms, and local cerebral blood flow (lCBF) in patients with chronic subdural haematoma (CSDH). METHODS: Forty five patients (age range 58-87 years, mean 71.9 (SD 8.4)) with unilateral CSDH were studied. Patients were categorised into three groups: I, headache (n=16); II, paresis (n=14); and III, mental change (n=15). T1 weighted MR images were obtained in all patients preoperatively. Quantitative values of maximum haematoma thickness, midline shift, and brain rotation angle were measured on axial and coronal MR images. In 21 patients, lCBF was measured by Xe enhanced CT. Values for lCBF were obtained in selected regions of interest in the frontal cortex, thalamus, and hemisphere on both the haematoma and contralateral sides. RESULTS: The lCBF reduction in the ipsilateral frontal cortex showed the best linear correlation with haematoma thickness (r=0.57), whereas the reduction in the ipsilateral thalamus had the most significant correlation with pineal shift (r=0.65) and third ventricle incline (r=0.67). In patients with paresis, lCBF decreased significantly on the ipsilateral side of both the frontal cortex and thalamus (p<0.05), whereas patients with mental change showed a significant reduction of lCBF on both sides of the thalamus (p<0.01) and in the ipsilateral frontal cortex (p<0.01). CONCLUSIONS: The lCBF reduction and clinical symptoms correlated well with local brain displacement in patients with CSDH. The lCBF in the central cerebral area including the thalamus was reduced in patients with clinical signs. The mental changes found were thought to derive from mild impairment of consciousness due to upper brain stem displacement.     

Chronic subdural haematoma after riding a roller coaster.

We report a 20-year-old man who developed a chronic subdural haematoma (CSDH) after riding a "giant" roller coaster. The patient had a past history of a subdural hygroma, diagnosed six weeks after a motorcycle accident. Three months after this accident, he rode on a roller coaster, but suffered no direct head trauma during the ride. Three weeks later, he developed a CSDH requiring surgical evacuation. Roller coaster riding, associated with high velocities and extreme acceleration/deceleration forces is a modern cause of CSDH in the young, which may be increasing due to ever-faster rides.     

Low incidence of seizures in patients with chronic subdural haematoma.

A total of 129 patients treated for chronic subdural haematoma were studied retrospectively to evaluate the incidence of seizures. None of 73 patients who were given prophylactic antiepileptic drug treatment developed seizures. Only two of 56 patients not given prophylaxis, developed early postoperative seizures. In these two, surgical technique was thought to be responsible. One patient developed complex partial seizures preoperatively. The incidence of seizures was therefore low, and similar to that previously reported for minor head injury. This study suggests that routine use of antiepileptic prophylaxis is not justified in patients with chronic subdural haematoma caused by minor head injuries, or other causes when there are no additional lesions present on CT scans.     

慢性硬膜下血肿行钻孔引流术后引流不畅原因分析

目的分析慢性硬膜下血肿行钻孔引流术后引流不畅的原因以及防治措施。方法回顾性分析2008年6月一2013年7月我院11例慢性硬膜下血肿钻孔引流后出现引流不畅病例的临床资料并进行总结。包括患者症状、CT表现、引流不畅的原因、处理的措施及愈合等。结果因纤维分隔物、纤维蛋白降解产物堵塞引起引流不畅4例;引流管"打折"、侧孔被血肿包膜包绕4例;血凝块堵塞2例;颅内压下降过快1例。本组病例无严重并发症。结论采用灌注尿激酶、调整引流管角度和深度、适当补液、调整患者头位等处理措施可以提高引流效果,改善患者预后。     

高压氧对中高海拔地区老年双侧慢性硬膜下血肿术后脑复张的疗效观察

目的探讨中高海拔地区高压氧治疗对老年双侧慢性硬膜下血肿（CSDH）钻孔引流术后脑复张的影响。 方法选取青海省人民医院神经外科自2010年1月至2017年12月收治的84例双侧CSDH老年患者,按照随机数字表法分为对照组和观察组。对照组：41例患者行双侧穿刺引流术后常规治疗;观察组：43例患者在术后常规治疗的基础上再加用高压氧治疗。根据术后复查头颅CT血肿残腔最大层面的厚度（T）,将脑复张程度分为4级（Ⅰ~Ⅳ级）。比较2组患者术后1、2个月脑复张程度的差异。 结果术后1个月,2组患者复查头颅CT后测量硬膜下残腔厚度显示,观察组的脑复张程度高于对照组,差异有统计学意义（P=0.002）。术后2个月,2组患者复查头颅CT后测量硬膜下残腔厚度显示,观察组的脑复张程度也高于对照组,差异有统计学意义（P=0.001）。 结论高压氧治疗能有效促进中高海拔地区双侧CSDH术后脑复张,可作为中高海拔地区CSDH术后常规辅助治疗措施。     

Contralateral acute epidural haematoma following evacuation of a chronic subdural haematoma with burr-hole craniostomy and continuous closed system drainage: a rare complication

Chronic subdural haematoma (CSDH) is one of the most frequent causes for neurosurgical intervention. Although the prognosis is generally good and treatment modalities are well established, some devastating intracranial haematomas can complicate its evacuation. The authors report here a case of an acute epidural haematoma occurring after evacuation of a contralateral chronic subdural haematoma (CSDH) with burr-hole craniostomy and continuous closed system drainage without irrigation. Since this is a rare, but potentially life-threatening, complication, clinicians should suspect its occurrence when an unexpected postoperative course is demonstrated.     

Chronic subdural haematoma preceded by persistent traumatic subdural fluid collection.

The role of traumatic subdural fluid collections in the development of chronic subdural haematomas was studied in 43 of 715 patients who underwent a CT scan because of a recent head injury. Twenty of the 43 patients subsequently developed a chronic subdural haematoma, and this occurred especially in the aged. Nearly 50% of patients with asymptomatic or minimally symptomatic subdural fluid collection may develop a chronic subdural haematoma.     

双侧慢性硬膜下血肿的微创治疗

目的 探讨双侧慢性硬膜下血肿的诊治方法及效果.方法 回顾性分析2001-04～2006-05收治的28例双侧慢性硬膜下血肿的临床资料,首诊即行颅脑CT检查22例（79%）,MRI检查16例（57%）.首诊误诊3例,漏诊1例.28例术前诊断均正确.治疗方法均采取局麻下行双侧钻单孔冲洗引流术.结果 27例术后均痊愈,1例出现硬膜下积液,全组无死亡病例.结论 双侧慢性硬膜下血肿确诊的首选方法是颅脑CT,必要时辅以MRI检查;双侧钻单孔微创术为首选治疗方法,效果良好.     

Successful conservative treatment of traumatic subacute subdural haematomas in neonates with haemophilia A

PURPOSE: The aim of this report is to enlighten the role of an early diagnosis and treatment of haemophilia A during the management of an intracranial haemorrhage as well as to discuss the efficiency of a subdural transcoronal puncture compared to a craniectomy as surgical treatment of the haematoma. BACKGROUND: Haemophilia A constitutes a well-known risk factor for intracranial bleeding. However, it has been rarely described as a cause of subdural haematoma in neonates. Management of subdural haematomas in haemophilic patients is still debated. MATERIALS AND METHODS: We report two cases of infants with subacute subdural haematoma. The first of them had a familial history of haemophilia A. In the second subject, the diagnosis was obtained during the etiological workup of an intracranial haematoma. Both infants were successfully treated with transcoronal puncture of the subacute component of the haematoma and factor VIII infusion. CONCLUSIONS: Transcranial punctures associated to infusion of factor VIII should be considered an alternative surgical option in the management of subdural haematomas in neonates with haemophilia A.     

Early post-operative seizures after burr-hole drainage for chronic subdural hematoma: correlation with brain CT findings.

The incidence of seizures in patients undergoing burr-hole crainiostomy with closed-system drainage for chronic subdural hematoma (CSDH) is low. The post-operative use of anticonvulsants is, thus, controversial. In this study, we tried to correlate pre-operative computed tomographic (CT) appearance of the CSDH with the need for post-operative seizure prophylaxis. From April 1998 to November 2001, 128 cases of CSDH surgically treated at our hospital were studied. All patients underwent burr-hole craniostomy with closed system drainage. All CSDHs were classified as low-density, isodense, and mixed-density lesions according to CT findings. The incidence of early post-operative seizures (within 3 weeks of surgery) among all patients was 5.4% (7/128). In the subgroups by lesion density, the incidences were 6.2% (1/16) in the low-density group, 2.4% (2/83) in the isodense group, and 13.7% (4/29) in the mixed-density group (all p < 0.05). The mean age among the seven patients (five males and two females) who had seizures was 71 years. The locations of the CSDHs among the 128 patients were the left side of the brain in 53 (41.4%) patients, right side in 45 (35.2%), and bilateral in 30 (23.4%) patients. Among the seven patients who suffered from post-operative seizures, five (71.4%) had left side CSDHs, one (14.2%) had a right side CSDH, and one (14.2%) had bilateral CSDHs. We concluded that the post-operative seizure rate appeared high in the group with mixed-density type lesions on CT, and in those with left unilateral CSDH. We suggest the use of prophylactic anticonvulsants for patients with mixed-density lesions on pre-operative CT.     

Spontaneous intracerebral haemorrhage following evacuation of chronic subdural hematomas.

Spontaneous intracerebral haematoma (ICH) is an extremely unusual complication following the evacuation of a chronic subdural haematoma (CSDH). Good outcome is expected after the drainage of the CSDH and neurological deterioration is a cause for serious concern. Authors report three cases of spontaneous ICH away from the site of surgery following evacuation of a CSDH with a review of literature. Changes in cortical blood flow following decompression of a long standing CSDH may be responsible for the ICH.     

Twist drill craniostomy with closed drainage for chronic subdural haematoma in the elderly: an effective method

OBJECTIVE: Chronic subdural haematoma is a disease of the elderly and surgery in these patients carries a much higher risk. The common surgical procedures for chronic subdural haematoma include twist drill craniostomy, burr hole evacuation or craniotomy. The aim of this study was to analyse the results of twist drill craniostomy with drainage in elderly patients with chronic subdural haematoma. METHODS: Forty-two elderly patients (>65 years) with radiologically proven chronic subdural haematoma were analysed. All the patients underwent twist drill craniostomy and continuous drainage of the haematoma under local anaesthesia and total intravenous anaesthesia (TIVA). RESULTS: There were 24 males and 18 females. Headache and cognitive decline was seen in 50% and weakness of limbs in 60% of patients. CT scan was done in all cases. All patients underwent twist drill 2-3cm in front of the parietal eminence under local anaesthesia. The drain was left for 24-72h depending on the drainage. At 1 week, 88% of patients had a good outcome. CONCLUSION: Twist drill craniostomy with drainage under local anaesthesia is a safe and effective procedure for chronic subdural haematoma in the elderly and could be used as the first and only option in these people.     

Postoperative neutrophil-to-lymphocyte ratio variation is associated with chronic subdural hematoma recurrence

Neurological Sciences - Chronic subdural haematoma (CSDH) is one of the most common neurosurgical pathologies. The recurrence of chronic subdural haematomas is an important concern, considering...     

Chronic subdural haematoma complicating spinal anaesthesia

Abstract Cranial subdural haematoma formation following spinal anaesthesia is exceptionally rare. A 38-year-old male developed headache two days after testicular surgery under spinal anaesthesia. The headache progressed in spite of analgesics, and three weeks later cranial CT showed a large chronic subdural haematoma in the left fronto-parietal region. The patient improved after surgical decompression. The pathogenesis of subdural haematoma formation after dural puncture is discussed and the literature briefly reviewed. Prolonged and severe post-dural puncture headache should be viewed with suspicion and investigated promptly to rule out any intracranial complication.     

Three cases of chronic subdural hematoma with depressive state

The authors described 3 cases of chronic subdural hematoma (CSDH) with a depressive state. There were no abnormal findings from general and neurological examinations. Computed tomographic (CT) brain scans revealed sickle-shaped low density areas in the bilateral frontal lobes. Two of the 3 cases had not had episodes of head contusion, and it was not until the CT brain scanning that they were found to have CSDH. Evacuation of the hematomas was not considered suitable and the depressive state of these 2 cases was improved by antidepressants. The remaining case seemed to have become depressive because of failure in business. After the head contusion, his depressive state gradually became more severe. A neurosurgical operation was carried out to evacuate the hematoma. CSDH seemed to aggravate his depressive state. These 3 cases show that CSDH located in the bilateral frontal lobes may cause and/or influence affective disorder.