慢性硬膜下血肿硬膜下引流时间与血肿复发的关系

目的 探讨慢性硬膜下血肿（CSDH）硬膜下引流时间与血肿复发的关系。方法 回顾性分析2017年3月至2022年10月单钻孔引流术治疗的114例CSDH的临床资料。根据术后引流时间分为三组：0～8 h组（n=47）、9～16 h组（n=33）、17～24 h组（n=34）。随访90 d,观察术后血肿复发情况。结果 144例中,术后复发20例,死亡4例;其中0～8 h组血肿复发14例（29.79%）,死亡3例（6.38%）;9～16 h组血肿复发4例（12.12%）,无死亡病例;17～24 h组血肿复发2例（5.88%）,死亡1例（2.94%）。0～8 h组血肿复发率显著高于9～16 h组和17～24 h组（P<0.05）,而三组病死率无统计学差异（P>0.05）。多因素logistic回归分析显示,引流时间较短是术后血肿复发的独立危险因素（P<0.05）。结论 CSDH单钻孔引流术后硬膜下引流的早期终止与血肿复发风险增加有关。早期监测术后硬膜下引流时间并预防早期引流终止可能有助于降低血肿复发率。     

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。     

慢性硬膜下血肿钻孔冲洗术后复发因素分析

目的探讨慢性硬膜下血肿钻孔术后复发的临床影响因素。方法回顾我科收治的218例慢性硬膜下钻孔手术病例,收集相关资料,建立EXCEL表格并完成相关分析,找出有统计学意义的影响因素。结果血肿厚度、有无分隔或脑萎缩、术后中线移位程度、手术前后中线变化值、术后积气程度及术后是否放置引流管6种因素是导致复发的原因,具有统计学意义。结论针对慢性硬膜下病人应采用个体化、综合化治疗方案,加强围手术期管理,提高手术疗效。     

老年慢性硬膜下血肿手术治疗的临床分析

目的分析老年硬膜下血肿（CSDH）的临床特征和手术治疗。方法回顾分析老年CSDH病人的临床特点、神经影像学资料、治疗方法和结果。结果本组118例中有106例病人首次手术均采用颅骨钻孔负闭式引流术，12例采用小骨瓣开颅血肿及包膜清除术。本组118例中，治俞108例，好转6例，死亡4例（均死于伴发疾病）。结论应重视老年CSDH的早期诊断，颅骨钻孔负闭式引流术是治疗老年CSDH的首选方法，小骨瓣开颅血肿及包膜清除术适用于壁厚、分隔的血肿。     

扭钻钻孔闭式引流治疗慢性硬膜下血肿

目的探讨扭钻钻孔后放置SubduralCatheterTM管闭式引流治疗慢性硬膜下血肿的疗效。方法对76例慢性硬膜下血肿病人采用颅骨钻孔SubduralCatheterTM 置管引流术。结果33例使用普通开颅钻孔术,6例因血肿复发需再次手术治疗;43例使用配套的专用扭钻钻孔,仅1例血肿复发,需再次手术。结论扭钻钻孔SubduralCatheterTM管闭式引流是治疗慢性硬膜下血肿的一种较佳方法,使用配套的专用扭钻可减少复发。     

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。     

单孔双管闭式引流治疗慢性硬膜下血肿

目的 探讨单孔双管闭式引流治疗慢性硬膜下血肿(CSDH)的临床治疗效果.方法 慢性硬膜下血肿患者随机按单孔单管额部引流组,单孔单管顶枕部引流组和单孔双管引流组,各选取30 例.分析其临床资料和影像学资料.结果 单孔双管引流组中线恢复好于其它二组(P ＜ 0.01),颅内积气和残留液体量三组比较均有显著差异(P ＜0.0...     

应用Subdural专用引流管治疗慢性硬膜下血肿

目的比较钻孔闭式引流和Subdural专用引流管穿刺引流在慢性硬膜下血肿(CSDH)中的疗效。方法回顾分析我院收治的88例CSDH患者,46例行钻孔闭式引流(A组),42例行Subdural专用引流管穿刺引流术(B组),比较两组治疗效果。结果A组40例一次钻孔引流成功,6例因继发颅内血肿而改行开颅手术,再手术率13.04%,癫发作3例;B组41例一次性引流成功,1例因继发血肿再次手术,再手术率2.38%,无癫发作。结论Subdural引流术较钻孔冲洗闭式引流术更微创、更安全有效,并发症少,宜作为治疗CSDH的首选方法。     

慢性硬膜下血肿钻孔引流后复发血肿护理

慢性硬膜下血肿系头外伤后3周以上始出现症状,位于硬膜与蛛网膜之间,具有包膜的血肿.好发于小儿及老年人,其治疗一般采用钻孔引流术,术后血肿复发率为3.7%～38%[1].     

微创穿刺术治疗慢性硬膜下血肿

我院自2001-2003年采用微创穿刺术治疗慢性硬膜下血肿28例，疗效满意，报道如下。     

Postoperative Course and Recurrence of Chronic Subdural Hematoma

Objective

Chronic subdural hematoma (CSDH) is known to have a significant recurrence rate. There are different criteria defining the recurrence of CSDH. We evaluated the postoperative course of CSDH and tried to propose the reasonable criteria of recurrence.

Methods

We retrospectively examined the medical records and pre- and postoperative CT scans of 149 consecutive patients who underwent surgery from January 2005 to December 2009. Diagnosis was confirmed by CT scanning or MRI. The postoperative courses were either resolved or recurrent. The resolved CSDH was one of the three types; early resolution, delayed resolution, or late resolution. The recurrent CSDH was one of the four types; recurrence without resolution, early recurrence after resolution, late recurrence after resolution, or recurrent-and-resolved type.

Results

The CSDH was resolved within 30 days after surgery in 58 (39%) patients, between 1 to 3 months in 62 (42%), and after 3 months in 11 (7%) patients. The CSDH was recurred in 18 (12%) patients. Late resolution or recurrence was more common in the aged. The recurrent hematoma was seen on the same side in 11 patients, on the different side in 7 patients. Recurrence was significantly more common in the thick hematomas.

Conclusion

For a working criteria of the recurrence of CSDH, we propose the early recurrence as return of symptoms or reaccumulation of the hematoma after a surgery within 3 months regardless of the location, amount or repeated operations. The late recurrence can be defined as reappearance or enlargement of a liquefied hematoma within the cranial cavity surrounded by the membranes or persistent CSDH beyond 3 months after surgery.     

One vs. Two Burr Hole Craniostomy in Surgical Treatment of Chronic Subdural Hematoma

Objective

Chronic subdural hematoma (CSDH) is one of the most common types of traumatic intracranial hemorrhage, usually occurring in the older patients, with a good surgical prognosis. Burr hole craniostomy is the most frequently used neurosurgical treatment of CSDH. However, there have been only few studies to assess the role of the number of burr holes in respect to recurrence rates. The aim of this study is to compare the postoperative recurrence rates between one and two burr craniostomy with closed-system drainage for CSDH.

Methods

From January 2002 to December 2006, 180 consecutive patients who were treated with burr hole craniostomy with closed-system drainage for the symptomatic CSDH were enrolled. Pre- and post-operative computed tomography (CT) scans and/or magnetic resonance imaging (MRI) were used for radiological evaluation. The number of burr hole was decided by neurosurgeon''s preference and was usually made on the maximum width of hematoma. The patients were followed with clinical symptoms or signs and CT scans. All the drainage catheters were maintained below the head level and removed after CT scans showing satisfactory evacuation. All patients were followed-up for at least 1 month after discharge.

Results

Out of 180 patients, 51 patients were treated with one burr hole, whereas 129 were treated with two burr holes. The overall postoperative recurrence rate was 5.6% (n = 10/180) in our study. One of 51 patients (2.0%) operated on with one burr hole recurred, whereas 9 of 129 patients (7.0%) evacuated by two burr holes recurred. Although the number of burr hole in this study is not statistically associated with postoperative recurrence rate (p > 0.05), CSDH treated with two burr holes showed somewhat higher recurrence rates.

Conclusion

In agreement with previous studies, burr hole craniostomy with closed drainage achieved a good surgical prognosis as a treatment of CSDH in this study. Results of our study indicate that burr hole craniostomy with one burr hole would be sufficient to evacuate CSDH with lower recurrence rate.     

Clinical Analysis of Risk Factors Related to Recurrent Chronic Subdural Hematoma

Objective

Burr hole drainage has been widely used to treat chronic subdural hematoma (CSDH). However, the incidence of recurrent CSDH varies from 3.7 to 30% after surgery. The authors attempted to elucidate the risk factors associated with the recurrence of CSDH in one burr hole drainage technique.

Methods

A total of 255 consecutive cases who underwent one burr hole drainage for CSDH were included in this study. Twenty-four patients (9.4%) underwent a repeated operation because of the recurrence of CSDH. We analyzed retrospectively the demographic, clinical and radiologic factors associated with the recurrence of CSDH.

Results

In this study, two risk factors were found to be independently associated with the recurrence of CSDH. The incidence of CSDH recurrence in the high- and mixed-density groups was significantly higher than those in the low- and iso-density groups (p<0.001). Bleeding tendency such as in leukemia, liver disease and chronic renal failure was also significantly associated with recurrence of CSDH (p=0.037).

Conclusion

These results suggest that high- and mixed- density shown on computed tomographic scan was closely relates with a high incidence of recurrence. Therefore, the operation could be delayed in those cases unless severe symptoms or signs are present. Reoperation using the previous burr hole site is a preferred modality to treat the recurrent CSDH.     

Spontaneous Resolution of Subdural Hematoma: MRI Findings

A 33-year-old man suffered a traumatic subdural hematoma with complete spontaneous resolution, as demonstrated by computed tomography scanning and magnetic resonance imaging. After resolution, there was obliteration of the subarachnoid space on the affected side, giving rise to relative dilation of the subarachnoid space over the uninvolved convexity. A resolved subdural hematoma should be considered in the differential diagnosis of such an asymmetry.     

外伤性慢性硬脑膜下血肿发生机理探讨

目的：探讨慢性硬脑膜下血肿（CSDH）的发生机理，方法：对我科1997年至1999年治疗的17例急性硬脑膜下血肿（ASDH），11例CSDH及9例硬脑膜下积液病人进行观察分析，结果：17例ASDH非手术治疗后无1例发展成为CSDH，9例硬脑膜下积液有2例发展成为CSDH，1例发展为张力性硬脑膜下积液。11例CSDH病人中，在第一次外伤后72h内头部CT示6例硬脑膜下积液，4例脑挫伤，1例无特殊显示，无一例为硬膜下血肿，结论：CSDH的发生可能与硬脑膜下积液有密切关系。     

The Surgical Treatment of Three Young Chronic Subdural Hematoma Patients with Different Causes

Chronic subdural hematoma (CSDH), which rarely happens in the young, is thought to be a disease of the elderly. Whereas unspecific symptoms and insidious onset in juveniles and young adults, as a result of its relative low morbidity, CSDH is usually neglected even undertreated in the young. Through the three cases and review of the current literature on this subject, we tried to illustrate the clinical and etiopathological characteristics of this entity and find out the most appropriate treatment strategy. We report three young CSDH patients with different but similar symptoms. The present histories, tests and examinations revealed different predisposing factors accounting for the genesis of CSDH. Their preoperative symptoms were all resolved with burr hole and drainage operation. Juveniles and young adults suffering from CSDH differ from that of their elderly counterparts in their clinical and etiopathological characteristics. Although trauma is the most important risk factor in young and old CSDH patients, some other predisposing factors may exist. Burr hole and drainage surgery could resolve the problem most of the time. But further tests and examinations even specific management should be made in some cases.     

Intracerebral Hemorrhage Following Evacuation of a Chronic Subdural Hematoma

Burr hole drainage has been widely used to treat chronic subdural hematomas (SDH), and most of them are easily treated by simple trephination and drainage. However, various complications, such as, hematoma recurrence, infection, seizure, cerebral edema, tension pneumocephalus and failure of the brain to expand due to cerebro-cranial disproportion may develop after chronic SDH drainage. Among them, intracerebral hemorrhage after evacuation of a recurrent chronic SDH is very rare. Here, we report a fatal case of delayed intracerebral hemorrhage caused by coagulopathy following evacuation of a chronic SDH. Possible pathogenic mechanisms of this unfavorable complication are discussed and a review of pertinent literature is included.     

Indications and Surgical Results of Twist-Drill Craniostomy at the Pre-Coronal Point for Symptomatic Chronic Subdural Hematoma Patients

Objective

Twist-drill craniostomy (TDC) with closed-system drainage and burr-hole drainage (BHD) with a closed system are effective treatment options for chronic subdural hematoma (CSDH). The aim of this study was to analyze clinical data and surgical results from symptomatic CSDH patients who underwent TDC with closed-system drainage at the pre-coronal point (PCP).

Methods

We analyzed data for 134 symptomatic CSDH patients who underwent TDC at the PCP with closed-system drainage. We defined the PCP for TDC to be 1 cm anterior to the coronal suture at the level of superior temporal line. TDC at the PCP with closed-system drainage was selected in patients with CSDH that extended beyond the coronal suture, confirmed by preoperative CT scans. Medical records, radiological findings, and clinical performance were reviewed retrospectively.

Results

Of the 134 CSDH patients, 114 (85.1%) showed improved clinical performance and imaging findings after surgery. Catheter failures were seen in two cases (1.4%); the catheters were inserted in the epidural space. Recurrent cases were seen in eight patients (5.6%), and they were improved with a second BHD with a closed-system operation.

Conclusion

TDC at the PCP with closed-system drainage is safe and effective for patients with symptomatic CSDH whose hematomas extend beyond the coronal suture.     

Recent Changes in Risk Factors of Chronic Subdural Hematoma

Objective

Chronic subdural hematoma (CSDH) is a typical disease that is encountered frequently in neurosurgical practice. The medications which could cause coagulopathies were known as one of the risk factors of CSDH, such as anticoagulants (ACs) and antiplatelet agents (APs). Recently, the number of patients who are treated with ACs/APs is increasing, especially in the elderly population. With widespread use of these drugs, there is a need to study the changes in risk factors of CSDH patients.

Methods

We retrospectively reviewed 290 CSDH patients who underwent surgery at our institute between 1996 and 2010. We classified them into three groups according to the time of presentation (Group A : the remote period group, 1996-2000, Group B : the past period group, 2001-2005, and Group C : the recent period group, 2006-2010). Also, we performed the comparative analysis of independent risk factors between three groups.

Results

Among the 290 patients, Group A included 71 patients (24.5%), Group B included 98 patients (33.8%) and Group C included 121 patients (41.7%). Three patients (4.2%) in Group A had a history of receiving ACs/APs, 8 patients (8.2%) in Group B, and 19 patients (15.7%) in Group C. Other factors such as head trauma, alcoholism, epilepsy, previous neurosurgery and underlying disease having bleeding tendency were also evaluated. In ACs/APs related cause of CSDH in Group C, significantly less proportion of the patients are associated with trauma or alcohol compared to the non-medication group.

Conclusion

In this study, the authors concluded that ACs/APs have more importance as a risk factor of CSDH in the recent period compared to the past. Therefore, doctors should prescribe these medications carefully balancing the potential risk and benefit.     

慢性硬膜下血肿3种治疗方法的疗效比较

目的:对119例慢性硬膜下血肿(CSDH)的临床资料,其中包括28例类固醇治疗成功的病例,进行比较,以期得出治疗该病的最有效方法。方法:将所有病例分成3个治疗组:冲洗引流组(A组,50例);冲洗抽吸引流组(B组,41例)和激素治疗组(C组,28例)。有91例接受手术治疗。28例接受类固醇治疗。对复发率等进行两两比较,采用Two-WayANOVA方差分析进行数据统计分析。结果:日常生活能力改善ADL评分,A组和B组差异无显著统计学意义;C组明显长于A组和B组(PA-C=0.035,PB-C=0.040)。复发率B组明显相似文献