慢性硬膜下血肿手术治疗36例临床分析

目的探讨慢性硬膜下血肿的临床特征及手术治疗。方法总结2009年1月-2014年2月收治36例慢性硬膜下血肿的手术治疗经验。36例中行单孔钻孔引流手术者34例（单侧29例,双侧5例）,开颅血肿清除术2例。结果钻单孔引流手术34例,临床症状明显改善33例,无明显变化者1例。2例开颅行血肿及包膜清除术者恢复良好。结论慢性硬膜下血肿应及时行颅脑CT明确诊断,及时手术治疗,预后较好,钻孔引流手术首选;对于身体条件较好,CT提示血肿呈混杂密度影、血肿内有分隔及壁厚者适合开颅行血肿清除及包膜清除术。     

慢性硬膜下血肿手术治疗68例分析

目的对慢性硬膜下血肿的临床特征及手术治疗进行探讨。方法总结2007-01—2012-05收治68例慢性硬膜下血肿的手术治疗经验。68例中行钻孔引流手术者60例(单侧52例,双侧8例),单孔引流57例,行双孔引流术3例,开颅血肿清除术8例。结果钻孔引流手术60例,临床症状明显改善56例,无明显变化者2例,引流管插入脑内致轻度偏瘫1例,并发对侧急性硬膜下血肿1例。开颅行血肿及包膜清除术者仅1例因继发脑梗死家属放弃进一步治疗,余7例均恢复良好。结论慢性硬膜下血肿应及时行颅脑CT或MRI检查明确诊断,及时手术治疗,预后较好。对于身体条件较好,血肿内有分隔及壁厚,CT提示血肿呈混杂密度影伴有钙化者适合开颅行血肿清除及包膜清除术。     

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.     

双侧慢性硬膜下血肿的诊治体会

目的探讨双侧慢性硬膜下血肿的诊治特点。方法26例高龄双侧慢性硬膜下血肿,全部病例均行头颅CT检查。2例在全麻下,其它在局麻下采取双侧钻单孔引流术。选定血肿最厚层面前中1／2到1／3处为钻孔点。结果漏诊一侧1例,其余术前诊断正确。25例术后痊愈,1例原有神经功能恢复不明显。结论仔细观察CT和选定合适的钻孔点是诊治的关键。     

慢性硬膜下血肿手术方法比较

目的 比较钻单孔冲洗引流术和钻双孔冲洗引流术治疗慢性硬膜下血肿的疗效及并发症发生率。方法 对80例慢性硬膜下血肿患者随机分两组,一组采用钻单孔冲洗引流术,另一组采用钻双孔冲洗引流术。术后48～72h复查头颅CT,对颅内积气、蛛网膜损伤发生率、血肿复发率、术后平均住院日进行比较。结果 两组所有患者均治愈出院,蛛网膜损伤发生率、血肿复发率、颅内积气发生率、平均住院日均无明显差异。结论 钻孔冲洗引流治疗慢性硬膜下血肿疗效满意,钻单孔可取代钻双孔。     

慢性硬膜下血肿手术方法比较

目的 比较钻单孔冲洗引流术和钻双孔冲洗引流术治疗慢性硬膜下血肿的疗效及并发症发生率。方法 对80例慢性硬膜下血肿患者随机分两组，一组采用钻单孔冲洗引流术，另一组采用钻双孔冲洗引流术。术后48～72h复查头颅CT，对颅内积气、蛛网膜损伤发生率、血肿复发率、术后平均住院日进行比较。结果 两组所有患者均治愈出院，蛛网膜损伤发生率、血肿复发率、颅内积气发生率、平均住院日均无明显差异。结论 钻孔冲洗引流治疗慢性硬膜下血肿疗效满意，钻单孔可取代钻双孔。     

单孔钻颅引流治疗慢性硬膜下血肿55例分析

慢性硬膜下血肿（chronic subdural hematoma,CSDH）约占颅内血肿的10%,起病隐匿,临床表现无特征性,单孔钻颅冲洗引流疗效好.我科自2000年1月至2005年5月单孔钻颅冲洗引流治疗慢性硬膜下血肿55例,效果满意,现报告如下.     

钻孔引流术治疗中青年慢性硬膜下血肿60例

目的探讨手术治疗中青年慢性硬膜下血肿的近期疗效。方法对60例中青年慢性硬膜下血肿患者采用钻单孔冲洗引流手术。结果60例患者均顺利手术,术后48～72h复查头颅CT示血肿引流干净。术后临床症状均有不同程度改善;均未发生颅内感染、张力性气颅及舾实质损伤等并发症。全部患者术后3月复查头颅cT示血肿全部吸收：随访1年未见复发。结论中青年慢性硬膜下血肿一旦确诊且存在颅内压增高症状,应积极施行手术治疗。     

单孔钻颅引流术治疗慢性硬膜下血肿80例临床分析

慢性硬膜下血肿（chronic subdural hematoma，CSDH）为受伤3W后出现硬膜下的血肿，是中老年患者轻微颅脑损伤后最为常见的颅内病变。约占颅内血肿的10％，起病隐匿，且临床表现无特征。虽然CSDH的治疗方法多种多样，但单孔钻颅闭式引流方法简单，操作容易，已成为神经外科医师普遍采用的方法。我们近3年来采用单孔钻颅闭式引流术治疗慢性硬膜下血肿80例，效果满意，现报告如下。     

以慢性硬膜下血肿为首诊的儿童颅内蛛网膜囊肿五例并文献复习

目的 探讨儿童颅内蛛网膜囊肿相关性的慢性硬膜下血肿的病因机制及治疗方法.方法 回顾性分析福建医科大学附属第一医院2006年1月至2012年4月5例以慢性硬膜下血肿为首诊患儿的临床资料,男4例,女1例,年龄4 ～11岁,平均7.2岁,均以典型颅高压表现首诊,其中1例并发癫痫,另1例并发健侧肢体无力;发病前3个月内明确颅脑损伤史1例,无明确外伤史4例.结果 5例患儿术后颅高压及脑神经功能损害症状均消失.4例张力性囊肿的患儿,血肿均在3d内引流干净,最短为术后1d.其中3例于术后3周-2个月内二期行囊肿一腹腔分流术,术后随访半年-2年,血肿无复发,蛛网膜囊肿均近全消失;而另1例合并囊肿腔内血肿的患儿引流6d后血肿大部消失,症状好转,术后4个月CT复查发现囊肿消失.结论 颅内蛛网膜囊肿是儿童发生慢性硬膜下血肿的重要病因;硬膜下血肿的形成可能是机体为修复蛛网膜囊肿壁裂口而启动一系列局部炎性反应促动过程的“副产品”;治疗上首选颅骨钻孔血肿外引流术.     

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.     

Chronic Subdural Hematomas : A Comparative Study of Three Types of Operative Procedures

Objective

Several surgical procedures have been reported for the treatment of chronic subdural hematoma (CSDH). We compared the results of treatments for CSDH obtained from one burr-hole craniostomy with closed system drainage with or without irrigation, two burr-hole craniostomy with closed system drainage with irrigation, and small craniotomy with irrigation and closed-system drainage.

Methods

Eighty-seven patients with CSDH underwent surgery at our institution from January 2004 to December 2008. Our patients were classified into three groups according to the operative procedure; group I, one burr-hole craniostomy with closed system drainage with or without irrigation (n = 25), group II, two burr-hole craniostomy with closed system drainage with irrigation (n = 32), and group III, small craniotomy with irrigation and closed-system drainage (n = 30).

Results

Age distribution, male and female ratio, Markwalder''s grade on admission and at the time of discharge, size of hematoma before and after surgery, duration of operation, Hounsfield unit of hematoma before and after surgery, duration of hospital treatment, complication rate, and revision rate were categories that we compared between groups. Duration of operation and hospitalization were only two categories which were different. But, when comparing burr hole craniostomy group (group I and group II) with small craniotomy group (group III), duration of post-operative hospital treatment, complication and recurrence rate were statistically lower in small craniotomy group, even though operation time was longer.

Conclusion

Such results indicate that small craniotomy with irrigation and closed-system drainage can be considered as one of the treatment options in patients with CSDH.     

Burr-hole versus twist-drill drainage for theevacuation of chronic subdural haematoma:a comparison of clinical results

BACKGROUND: Most neurosurgeons remove clinically symptomatic subdural haematomata, but the techniques they choose remain controversial. METHOD: The results from sixty-two patients diagnosed with chronic subdural haematoma were evaluated for technique, postoperative computerized tomography (CT) scan results, and complications. RESULTS: Eleven patients had haematomata evacuated using twist-drill plus drain, 37 patients had haematomata evacuated with burr-hole only, and 14 patients were evacuated with burr-hole plus drain. Of the patients who underwent twist-drill and closed system drainage (CSD), 43% had smaller lesions on CT follow-up scans, as compared with 74% of those who underwent the burr-hole only procedure, and 65% with burr-holes with drains. Clinical outcome results showed that 64% of twist-drill and CSD patients deteriorated as compared with 16% of those with burr-hole only and 7% with burr-holes and CSDs. Sixty-four per cent of twist-drill patients required repeat evacuations as compared with 11% of those with burr-holes only, and 7% with burr-holes plus drains. CONCLUSION: The results at our institution indicate that burr-hole evacuation for chronic subdural haematoma is superior to twist-drill evacuation with respect to clinical outcomes and complications.     

Comparison of the Indications and Treatment Results of Burr-Hole Drainage at the Maximal Thickness Area versus Twist-Drill Craniostomy at the Pre-Coronal Point for the Evacuation of Symptomatic Chronic Subdural Hematomas

ObjectiveTo analyze the clinical data and surgical results from symptomatic chronic subdural hematoma (CSDH) patients who underwent burr-hole drainage (BHD) at the maximal thickness area and twist-drill craniostomy (TDC) at the precoronal point.MethodsWe analyzed data from 65 symptomatic CSDH patients who underwent TDC at the pre-coronal point or BHD at the maximal thickness area. For TDC, we defined the pre-coronal point to be 1 cm anterior to the coronal suture at the level of the superior temporal line. TDC was performed in patients with CSDH that extended beyond the coronal suture, as confirmed by preoperative CT scans. Medical records, radiological findings, and clinical performance were reviewed and analyzed.ResultsOf the 65 CSDH patients, 13/17 (76.4%) with BHD and 42/48 (87.5%) with TDC showed improved clinical performance and radiological findings after surgery. Catheter failure was seen in 1/48 (2.4%) cases of TDC. Five patients (29.4%) in the BHD group and four patients (8.33%) in the TDC group underwent reoperations due to remaining hematomas, and they improved with a second operation, BHD or TDC.ConclusionBoth BHD at the maximal thickness area and TDC at the pre-coronal point are safe and effective drainage methods for symptomatic CSDHs with reasonable indications.     

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。     

Management of chronic subdural hematoma: a national survey and literature review

OBJECTIVE: To survey neurosurgical practices in the treatment of chronic and subacute subdural hematoma in the Canadian adult population. METHODS: We developed and administered a questionnaire to Canadian Neurosurgeons with questions relating to the management of chronic and subacute subdural hematoma. Our sampling frame included all neurosurgery members of the Canadian Neurosurgical Society. RESULTS: Of 158 questionnaires, 120 were returned (response rate = 76%). The respondents were neurosurgeons with primarily adult clinical practices (108/120). Surgeons preferred one and two burr-hole craniostomy to craniotomy or twist-drill craniostomy as the procedure of choice for initial treatment of subdural hematoma (35.5% vs 49.5% vs 4.7% vs 9.3%, respectively). Craniotomy and two burr-holes were preferred for recurrent subdural hematomas (43.3% and 35.1%, respectively). Surgeons preferred irrigation of the subdural cavity (79.6%), use of a subdural drain (80.6%), and no use of anti-convulsants or corticosteroids (82.1% and 86.6%, respectively). We identified a lack of consensus with keeping patients supine following surgery and post-operative antibiotic use. CONCLUSION: Our survey has identified variations in practice patterns among Canadian Neurosurgeons with respect to treatment of subacute or chronic subdural hematoma (SDH). Our findings support the need for further prospective studies and clinical trials to resolve areas of discrepancies in clinical management and hence, standardize treatment regimens.     

Prospective analysis of bedside percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults

OBJECTIVES: Although there is general agreement that surgery is the best treatment for chronic subdural haematoma (CSDH), the extent of the surgical intervention is not well defined. METHODS: The less invasive surgical technique of bedside percutaneous subdural tapping and spontaneous haematoma efflux after twist drill craniostomy under local anaesthesia was prospectively analysed in 118 adult patients, 99 with unilateral and 19 with bilateral CSDH. RESULTS: The mean number of subdural tappings was 3.2. Ninety two of the patients with unilateral CSDH were successfully treated by up to five subdural tappings, 95% of the patients with bilateral CSDH were successfully treated by up to 10 subdural tappings. The mean duration of inpatient treatment was 12 days. In 11 patients (9%) the treatment protocol had to be abandoned because of two acute subdural bleedings, two subdural empyemas, and seven cases of insufficient haematoma efflux and no neurological improvement. The only significant predictor for failure of the described treatment protocol was septation visible on preoperative CT. CONCLUSIONS: The described therapy protocol is-apart from a purely conservative treatment-the least invasive presently available surgical technique for treating chronic subdural haematoma. Its results are comparable with other modern treatment protocols. Thus, it can be recommended in all patients as a first and minimally invasive therapy, especially in patients in a poor general condition. Patients with septation visible on preoperative CT should be excluded from this form of treatment.     

A case of interhemispheric subdural empyema with sinusitis diagnosed by diffusion-weighted MRI]

The patient was a 29-year-old man with sinusitis. He was admitted with high grade fever, headache, vomiting and disturbance of consciousness. Neurological examination revealed nuchal rigidity, aphasia, right hemiparesis, right sensory disturbance and bilateral Babinski signs. A nonenhanced CT on admission showed a low density area in the interhemispheric fissure. Gadolinium-enhanced MRI and DWI showed an interhemispheric subdural empyema and sinusitis. Neurological deficits gradually improved, after he underwent urgent surgical drainage of sinusitis followed by antibiotics therapy. About three weeks later, he developed right hemiparesis and disturbance of consciousness, and MRI demonstrated the expansion of interhemispheric subdural empyema. Therefore, he underwent surgical drainage of interhemispheric subdural empyema. He was discharged from our hospital without neurologic deficit. We suggest that MRI, in particular DWI, is a useful additional imaging modality for the diagnosis of interhemispheric subdural empyema.     

硬通道微创穿刺与钻孔引流治疗慢性硬膜下血肿的疗效对比观察

目的探讨两种不同手术方式对于慢性硬膜下血肿患者治疗效果的临床差异性。方法将收治的623例慢性硬膜下血肿手术患者的临床资料作回顾性分析及对比研究,其中335例采用YL-1微创穿刺手术,288例采用钻孔引流手术。结果在手术时间、住院时间方面,两种术式有统计学差异(P0.05)。两种手术方式的治愈率、并发症发生率无明显差异(P0.05),穿刺组有1例患者因新鲜出血行骨瓣开颅。结论对于慢性硬膜下血肿患者,钻孔引流术是经典术式,微创穿刺术亦有明确疗效,且操作方法简便、创伤小,住院周期及花费少,在临床应用中可进一步推广。