Percutaneous twist-drill craniostomy for the treatment of chronic subdural haematoma

Summary A consecutive series of 65 adult patients with chronic subdural haematoma was reviewed to ascertain the efficacy of twist-drill craniostomy and closed-system catheter drainage. In all patients but two the percutaneous evacuation of the haematoma alone was enough to bring about their recovery.Infections or neurological complications were never observed. Pneumocephalus was likewise absent in all patients. Therefore this technique should be recommended as the first intention management of the disease, particularly in elderly patients.     

Complications of burr-hole craniostomy and closed-system drainage for chronic subdural hematomas: a retrospective analysis of 376 patients

Objective. Burr-hole craniostomy with closed-system drainage (BCD) is the most frequently used neurosurgical treatment of chronic subdural hematomas (cSDH).The surgical and medical complications of BCD have seldom been investigated systematically. The objective of this study was to define the frequency of surgical and medical complications following BCD for cSDH. Methods. The medical records of 376 patients managed by BCD were reviewed with respect to complications during the hospital stay. Results. Seventy-seven surgical complications (20.5%) were encountered . The most frequent minor complication after surgery was seizures (n 51, 13.6%). The most frequent major surgical complications were intracerebral hemorrhage and subdural empyema (n 8, 2.1% each). Four patients with intracerebral hemorrhage died, accounting for a surgical mortality rate of 1.1%. Fifty-nine medical complications (15.7%) occurred during the hospital stay. Pneumonia was the most frequent medical complication (n 29, 7.7%). Medical complications were fatal in 24 patients, accounting for a mortality rate of 6.4%. In 22 patients (5.8%), death was not related to a complication, but to the initial brain damage. The overall mortality rate was 13.3%. Conclusion. The rate of complications in patients with cSDH who underwent the BCD is high. The clinical relevance of medical complications has to be emphasized because of their substantial contribution to overall mortality. Electronic Publication     

An implantable subdural drain for treatment of chronic subdural hematoma

We describe a drain that is implanted at operation for a chronic subdural hematoma. The drain provides access to the subdural space and can therefore be used for percutaneous aspiration of reaccumulation of subdural effusions.     

Acute subdural haematoma successfully treated by percutaneous subdural tapping in an elderly patient

Summary An elderly patient suffering acute subdural haematoma associated with cerebral contusion was treated by percutaneous subdural tapping while preparing for craniotomy. Most of the subdural haematoma, though of high density on computed tomography scanning, proved to be semiliquid. Drainage of the haematoma yielded resolution of the mass effect, and was followed by a rapid improvement of consciousness. This observation suggests the significance of trial subdural tapping for the treatment of acute traumatic subdural haematoma prior to craniotomy.     

A new simple therapeutic method for chronic subdural hematoma without irrigation and drainage

Summary Background. We developed a new simple therapeutic method for the treatment of chronic subdural hematoma (CSDH) without irrigation and drainage. This method is characterized by replacement of the hematoma with oxygen. Methods. Seventy patients (seventy-eight sides) with CSDH were treated with this method from May 1994 to October 2002. For the complete replacement of the hematoma with oxygen, subdural tapping site was changed from the thickest area of the hematoma to the parietal tuber. Irrigation and drainage were not used in all patients. Results. Neurological recovery after the treatment was satisfactory in all 70 patients. An average amount of replaced hematoma was 96.1 ml, ranging from 5 to 280 ml. An initial hematoma pressure ranged from 0 to 200 mm H₂O (average: 92.1 mm H₂O). During the follow up periods, clinical recurrence was noted in 7 patients (10%) and 7 sides (9.0%). Conclusion. The replacement of the hematoma with oxygen via percutaneous subdural tapping without irrigation and drainage is useful and less invasive method for the treatment of CSDH.     

自发性椎管内硬膜外、硬膜下血肿的诊断和治疗

探讨比较自发性硬脊膜外、硬膜下血肿的出血原因、临床表现、影像特征及治疗预后。结合相关文献,回顾性分析7例自发性硬脊膜外血肿和1例自发性硬膜下血肿的流行病学、发病机制、部位,临床特征、神经功能状态,以及手术,保守治疗和预后。结果有6例患者手术治疗,1例痊愈,2例保守治疗,1例痊愈。自发性硬脊膜外,硬膜下血肿多急性起病,硬脊膜外较硬膜下血肿更为常见,且MRI显示椎管内占位影较CT明显。MRI检查是诊断本病最佳方法。手术减压是改善预后的主要方法。起病到治疗的时间间隔越短预后越好。     

Acute subdural hematoma: Outcome and outcome prediction

Patients with traumatic acute subdural hematoma were studied to determine the factors influencing outcome.Between January 1986 and August 1995, we collected 113 patients who underwent craniotomy for traumatic acute subdural hematoma. The relationship between initial clinical signs and the outcome 3 months after admission was studied retrospectively.Functional recovery was achieved in 38% of patients and the mortality was 60%. 91% of patients with a high Glasgow Coma Scale (GCS) score (9–15) and 23% of patients with a low GCS score (3–8) achieved functional recovery. All of 14 patients with a GCS score of 3 died. The mortality of patients with GCS scores of 4 and 5 was 95% to 75%, respectively. Patients over 61 years old had a mortality of 73% compared to 64% mortality for those aged 21–40 years. 97% of patients with bilateral unreactive pupil and 81% of patients with unilateral unreactive pupil died. The mortality rates of associated intracranial lesions were 91% in intracerebral hematoma, 87% in subarachnoid hemorrhage, 75% in contusion.Time from injury to surgical evacuation and type of surgical intervention did not affect mortality. Age and associated intracranial lesions were related to outcome. Severity of injury and pupillary response were the most important factors for predicting outcome.     

Comparing twist-drill drainage with burr hole drainage for chronic subdural hematoma

Objective

The surgical management of chronic subdural hematoma (CSDH) is still a controversial issue, and a standard therapy has not been established because of the unclear pathogenic mechanisms in CSDH. The intention of this paper is to find a simple and efficient surgical procedure for CSDH.

Methods

A retrospective study of 448 patients with CSDH by surgical treatment during 2005 to 2009 was conducted in order to compare the efficiency between two different primary surgical methods, i.e. twist-drill drainage with-out irrigation in Group A (n=178) and one burr-hole with irrigation in Group B (n=270). The results were statistically analyzed.

Results

The reoperation rates in Group A and Group B were 7.9% and 11.9% respectively. The good outcome rate was 88.8% and 75.5%, the complication was 7.9% and 20.7% in Group A and Group B, respectively.

Conclusions

The burr-hole drainage with irrigation of the hematoma cavity is not beneficial to the outcome and prognosis. Irrigation is not important in the surgical treatment for C S D H. Thus in initial treatment, twist-drill drainage without irrigation of the hematoma cavity is recommended because it is relatively safe, time-saving and cost-effective.     

神经内窥镜治疗分隔型慢性硬膜下血肿(45例报告)

目的　评估神经内窥镜治疗分隔型慢性硬膜下血肿 (SCSH)的疗效及优点。　方法　通过单一钻孔用内窥镜显微剪分离血肿腔内隔膜并冲洗引流血肿液 ,治疗 4 5例分隔型慢性硬膜下血肿。　结果　所有病例治疗有效 ,原有意识状况、定位体征改善 ,无血肿复发、感染、脑水肿、颅内出血、积气及新的神经功能缺失。　结论　神经内窥镜是治疗分隔型慢性硬膜下血肿安全、有效、便捷的微侵袭技术。     

手锥锥颅、CO2气体置换治疗慢性硬膜下血肿

目的 探讨手锥单孔锥颅冲洗、CO2气体置换慢性硬膜下血肿(Chronic subdural hematoma,CSDH)的手术疗效。方法 使用微创手锥单孔锥颅,经双腔导管冲洗引流、注入CO2气体置换血肿,不放置引流管治疗41例慢性硬膜下血肿。结果 41例CO2气体术后24小时吸收,症状体征消失,1例2周后再出血复发。随访1月至2年,无颅内感染、张力性气颅、继发性颅内血肿、癫痫等并发症。结论 微创手锥锥颅、CO2气体置换CSDH是一种手术简便、创伤小、不置引流管、血肿腔可迅速闭合、复发率低的有效手术方法。     

Computed tomography features immediately after replacement of haematoma with oxygen through percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults

Summary In an effort to achieve a simple and less invasive method for the treatment of chronic subdural haematoma, replacement of the haematoma with oxygen by percutaneous subdural tapping was employed in 36 patients. This study was conducted on 23 haematomas in 20 patients, whose computed tomography (CT) scans immediately following the treatment were available for evaluation, with particular regard to distinguishing between their findings and those seen with tension pneumocephalus. The CT features werde divided into two patterns according to the location of oxygen; a convexity type (19 haematomas) and an interhemispheric type (4 haematomas). Analysis of the CT appearances revealed the oxygen was exclusively confined to the haematoma cavity, distinguishing it from the findings in tension pneumocephalus. This observation indicates the safety of replacement of the haematoma with oxygen when combined with our percutaneuous subdural tapping technique which prevents lesions of the inner haematoma membrane.     

老年重症慢性硬膜下血肿的微创治疗

目的 探讨微创手术方法在老年重症慢性硬膜下血肿的应用价值。方法 1997年2月-2001年2月对34例老年重症慢性硬膜下血肿(Chronic subdural hematoma，CSDH)采用经皮颅内血肿前(上)部穿刺、浅置管、注入尿激酶液化血肿、辅以促进受压脑组织复位等措施进行回顾性分析。结果 术前血肿量平均97ml；术后血肿清除或基本清除。受压脑组织复位时间24h-96h，平均42h。均痊愈出院。29例术后随访3月-48月，平均19月，Barthel指数评分正常22例，生活自理7例；CT随访21例，正常14例，脑萎缩5例，轻度局限性硬膜下积液2例。结论 微创血肿清除术尤其适合老年CSDH的治疗，疗效满意,复发率低。     

Combined epidural and intracerebral hematomas after evacuation of bilateral chronic subdural hematoma

Bleeding after surgery for chronic subdural hematoma far from the operative site is a rare phenomenon with possibly serious consequences. We report a case of combined epidural and intracerebral hemorrhage immediately after evacuation of bilateral chronic subdural hematoma. The epidural hematoma was evacuated by emergency craniotomy, but the deep parenchymal hematoma was treated conservatively. The patient recovered progressively with a good outcome. Approximately 30 cases of chronic subdural hematomas complicated by intracerebral hematoma were previously reported, but only seven cases of epidural hematoma. These complications could be avoided if slow, gradual decompression is used during surgery. Clinicians should suspect its occurrence without delay when a postoperative neurological deterioration is demonstrated. Possible mechanisms are discussed.     

急性硬膜外血肿的手术治疗体会

【摘要】 目的 总结急性硬膜外血肿的临床诊治经验。方法 回顾性分析自2005年至2012年间在我院住院治疗的75例急性硬膜外血肿患者的临床资料的临床资料;所有患者均行骨瓣开颅血肿清除手术治疗。结果 75例患者中59例治愈,8例好转,2例重残,6例死亡,总有效率为89.33%。结论 急性硬膜外血肿是临床上的急重症,通过早期积极的手术治疗,可以取得满意的疗效。     

脑膜中动脉栓塞术治疗慢性硬膜下血肿:Meta分析

目的 系统评价脑膜中动脉(MMA)栓塞术治疗慢性硬膜下血肿(CSDH)的有效性及安全性。方法 检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方医学网及维普数据库自建库至2021年11月栓塞MMA或以传统手术治疗CSDH相关临床队列研究,依据纳入及排除标准筛选文献,采用Stata 16.0软件进行分析。结果 最终纳入8篇文献、共1 482例CSDH患者,根据治疗方法分为栓塞组(n=318)及传统手术组(n=1 164)。栓塞组中,70例接受单纯MMA栓塞;其中248例接受栓塞联合手术治疗,包括67例术前栓塞、32例术后辅助栓塞、118例术后复发补救栓塞和31例未提及栓塞时机。Meta分析结果显示,栓塞组治疗失败率[RR＝－1.28,95%CI(－2.09,－0.47),P<0.05]、再次手术干预率[RR＝－1.59,95%CI(－2.27,－0.91),P<0.05]均低于传统手术组,而治疗相关并发症发生率组间差异无统计学意义[RR＝－0.40,95%CI(－0.93,0.13),P=0.13]。结论 MMA栓塞术治疗CSDH安全、有效。     

Twist-drill craniostomy for the treatment of chronic subdural hematoma

The choice of the initial surgical method for treating the patient with CSH is influenced by the patient's neurologic status at the time of presentation, associated medical factors, and the surgeon's experience in the management of these patients. The outcome data suggest that twist-drill craniostomy with closed-system catheter drainage results in an equivalent or superior outcome to the historical results of craniotomy with membranectomy. Craniotomy remains the treatment of choice when the admitting computerized tomographic scan demonstrates a significant hyperdense component suggesting the presence of solid or mixed hematoma.     

口服阿托伐他汀钙片联合钻孔引流术治疗慢性硬膜下血肿的疗效分析

目的比较口服阿托伐他汀钙片联合钻孔引流术与单纯钻孔引流术治疗慢性硬膜下血肿(CSDH)的疗效。方法收集中山大学孙逸仙纪念医院与广东同江医院2016年1月至2017年7月期间行钻孔引流术治疗的慢性硬膜下血肿患者资料,以是否辅助口服阿托伐他汀钙片将患者分为观察组36例与对照组32例。观察组行钻孔引流术后辅以口服阿托伐他汀钙片8~12周,对照组单纯行钻孔引流术,然后对比两组间治疗效果,以及术后第8周Karnofsky(KPS)功能状态评分差异。结果观察组总有效率(97.22%)与对照组(84.38%)差异无统计学意义(χ~2=2.062,P=0.151),而观察组治疗效果则优于对照组(Z=-2.413,P=0.016)。观察组复发率(0%)低于对照组(12.5%),差异有统计学意义(χ~2=4.711,P=0.03)。术后第8周KPS评分,观察组平均评分(92.78±9.74)高于对照组(87.19±12.50),差异有统计学意义(Z=-2.093,P=0.036)。结论口服阿托伐他汀钙片联合钻孔引流术治疗慢性硬膜下血肿效果优于单纯钻孔引流术,且血肿复发率低,更有助于患者术后神经功能恢复。     

Surgical complications of chronic subdural haematoma: A 5‐year audit

Objective: To review the outcome of surgical treatment for chronic subdural haematoma (CSDH) at a local neurosurgical centre, with emphasis on major treatment‐related complications. Method: A total of 108 patients received operations for chronic subdural haematoma at the University of Hong Kong Medical Centre between January 1995 and December 1999. Medical records and imaging studies were studied retrospectively. Patients’ clinical features and treatment modalities were analysed and major postoperative complications, including mortality, haematoma recurrence, infection and epileptic seizure, were studied. Results: All 108 patients underwent burr hole craniostomy for the drainage of CSDH; one patient also underwent formal craniotomy. Recurrence occurred in six (5.5%) patients, seizure in two (1.8%) and intracranial infection in one (0.9%). There were four deaths, giving rise to a mortality of 3.7%. All four patients who died were elderly and had presented in an unconscious state and died subsequently of chest infection after surgery. Conclusion: Although surgical drainage of CSDH is often considered to be a straightforward, effective and safe procedure, it is not entirely without risks. The surgical outcome of the present series is in accordance with the current standard of neurosurgical care.     

多次复发难治性慢性硬膜下血肿21例的原因及治疗

目的　探讨反复复发、两次或两次手术以上难治性慢性硬膜下血肿（chronic subdural hematoma, CSDH）的原因及治疗方法。方法　总结分析21例患者的临床资料,结合有关文献进行相关分析。结果　21例难治性CSDH患者中,血肿钻孔引流手术史2次者15例,3次者4例,4次者2例。治疗前CT/MRI扫描发现明显脑萎缩12例,血肿包膜形成8例,血肿分隔多房5例,血肿机化3例。对5例无血肿分房分隔、包膜明显强化及血肿机化的患者仅再行血肿穿刺冲洗引流术,余16例行骨瓣开颅血肿清除+包膜切除术。术后均给予1~2疗程高压氧治疗。随访3~6个月,症状明显改善或消失,无围手术期死亡。术后3个月CT或MRI检查,5例呈硬膜下积液表现,其中2例有占位效应再次行钻孔引流+高压氧治疗;术后6个月,4例有少量硬膜下积液,较前好转,无新复发病例。结论　高龄脑萎缩、包膜形成、血肿分隔多房、血肿机化为难治性CSDH的主要原因;根据不同原因采用开颅血肿和包膜切除或钻孔冲洗引流术+高压氧等治疗可提高治疗效果。