慢性硬膜下血肿20例临床分析

目的 分析慢性硬膜下血肿(CSDH)的临床特征。方法 收集20例CSDH，就其临床表现、发病机制及防治和预后进行临床探讨。结果 CSDH临床症状不典型，尤其是老年人，初诊误诊率达50％，积极治疗治愈率达100％。结论 应重视CSDH的早期诊断。     

Factors affecting the survival following surgical treatment of chronic subdural haematoma: Single institutional experience

BackgroundChronic subdural haematoma (CSDH) is one of the most commonly treated condition in neurosurgery. It affects elderly populations who often have significant medical co-morbidities resulting in poor prognosis. The study aimed at identifying clinical factors influencing the survival following surgical management of CSDH.MethodsRetrospective study included 267 cases that underwent surgery for CSDH and followed over 5-year period (2010–2015); data retrieved with reference to operation details, radiology reports and discharge. Using logistic and Cox regression analysis, the patient survival data was analysed with respect to patient demographics, type of surgery, co-morbidities, anticoagulation treatment, and discharge destination.ResultsThe overall survival in the cohort was 37.0 months (IQR: 20.0–60.0). The median age of the patients was 76 years (IQR: 66–82) and the median length of hospital stay was 10 days (range 1–126 days; IQR: 6–17 days). The recurrence rate was 6.37% (n = 17). Fifty-three (19.85%) patients recorded deceased on the IPM database as of October 2016 and of those 11 died in hospital. Univariate Cox-regression analysis revealed increased age (HR: 1.80; 95%CI: 1.04–3.11), length of hospital stay (HR: 2.50; 95%CI: 1.41–4.41) and number of co-morbidities (HR: 2.19; 95%CI: 1.26–3.79) were associated with poor prognosis. Glasgow coma scale (GCS) at discharge was found to be significantly associated with survival whilst anticoagulation treatment did not. Multivariate analysis confirmed similar findings significant statistically.ConclusionAge at admission, median length of hospital stay, number of co-morbidities, GCS at discharge and discharge destination have been found to influence survival significant statistically.     

Drug treatment of chronic subdural hematoma

ABSTRACT

Introduction: Chronic subdural hematoma (CSDH) is a common neurosurgical disease, whose incidence has been steadily increasing with our aging population. While not common, CSDH can also occur in children. CSDH is often associated with traumatic head injury, but its underlying mechanism remains poorly understood. The first line treatment for CSDH is surgery. However, surgery is contraindicated in some patients and has a high rate of recurrence. Effective non-surgical treatment is therefore highly desirable.

Areas covered: This review discusses the pathogenesis of CSDH and drugs that have been used to treat CSDH either as monotherapy or an adjuvant to surgery, including controlled clinical trials.

Expert opinion: The pathophysiology of CSDH remains poorly understood. Developing effective drug treatments is therefore challenging. Most drugs discussed in this review are evaluated in small clinical studies without sufficient sample size and controls for confounding variables. More controlled clinical trials are therefore needed to carefully evaluate drugs for the non-surgical treatment of CSDH, especially for drugs targeting specific pathogenic pathways of CSDH.     

微创穿刺治疗高龄老年人慢性硬膜下血肿的临床观察

目的 总结微创穿刺引流术在高龄老年慢性硬膜下血肿手术中的临床应用效果.方法 2010年1月至2014年6月收治的年龄＞ 80岁的CSDH患者48例,予以微创穿刺术治疗,并对患者手术效果、手术并发症、血肿复发情况进行观察及分析,对所有出院患者进行随访,总结治疗效果.结果 48例微创手术均成功,治愈率100％,48例患者全部获得随访,随访时间3个月,全组患者均取得较满意治疗效果.结论 微创穿刺引流术疗效好,具有操作简便、住院时间短、恢复快的优点,可作为基层医院高龄老年患者的首选手术方式.     

改良式CSDH钻孔引流

临床资料 本组27例，男21例，女6例，年龄42～78岁，平均65岁。均有明确外伤史，其中车祸伤18例，所有病人受伤至出现症状时间最短1个月，最长18个月。均经头颅CT及MRI确诊为CSDH。方法：选择血肿腔中心外为最佳钻颅点，咬骨钳扩大骨洞约20cm^2．电凝“十”字型切片硬膜后悬吊，血肿腔内彻底冲洗后，取“10”号橡胶导尿管两根，根据血肿腔大小剪取侧孔3～5个，一根置入枕骨顶部，一根置入颞部，引流管自切口旁头皮戳孔引出，预置缝线，待日拔管后头皮打结，术后根据复查头颅CT或MRI情况，拔除引流管，引流时间1～3d。     

老年人慢性硬脑膜下血肿的诊断与手术治疗

目的探讨老年人慢性硬脑膜下血肿（CSDH）的诊断特点与手术方法。方法对37例经手术治疗的老年人慢性硬脑膜下血肿的临床资料进行回顾性分析，37例病人均采用颅骨钻孔冲洗并闭式引流术。结果术后2周内复查，15例残留少量血肿，2例复发而再次手术；8例颅内积气，2例手术后出现脑内出血，经治疗后留有中残；术后随访6～72个月，无手术病死。结论CT扫描或MRI检查可及时诊断老年人CSDH。颅骨钻孔冲洗并闭式引流术是治疗老年人CSDH安全有效的首选方法。     

a-SMA与Vimentin在慢性硬膜下血肿外膜中的表达及意义

目的 采用a-平滑肌肌动蛋白（a-SMA）与波形蛋白 （VIM）鉴定和分类慢性硬膜下血肿（CSDH）外膜中的肌成纤维细胞 （MFB）,并探讨两者表达的意义.方法 选取CSDH 9例患者的硬脑膜和其下的血肿膜,采用免疫组化法检测a-SMA和VIM在CSDH外膜中的表达,采用透射电镜观察细胞形态结构.结果 CSDH血肿膜中细胞数量较多,可见许多新生毛细血管;共同表达a-SMA和VIM的细胞有两种,其中一类细胞呈梭形（为肌成纤维细胞）,另一类是血管管壁的细胞（为血管内皮细胞）;阳性表达的棕黄色颗粒状均位于胞质内.电镜观察可见MFB细胞特征性形态,胞核有很多切迹,沿细胞长轴的边缘有束状肌动蛋白细丝排列.结论 a-SMA与VIM的广泛表达和持续分布可能在CSDH的发生发展中有重要作用.     

双孔钻颅血肿冲洗引流术治疗慢性硬膜下血肿47例报告

慢性硬膜下血肿 (CSDH)是头部损伤后 3周开始出现症状 ,位于硬脑膜与蛛网膜之间 ,具有包膜的血肿 [1 ] 。我科自1 9 94年 1月至 2 0 0 0年 4月共收治 CSDH 47例 ,现分析报告如下。1　临床资料与方法1 .1　一般资料本组男 37例 ,女 1 0例 ,年龄 31～ 80岁 ,平均 63岁 ,其中50岁以上 41例 ,占 87% ;有明显头部外伤史 34例 ,占 72 % ,无明显外伤史 1 3例 ,占 2 8%。1 .2　临床表现及病情分级 级 :意识清楚 ,轻微头痛 ,有轻度神经功能缺失或无 ,1 5例 ,占 31 .9% ; 级 :定向力差或意识模糊 ,有轻度偏瘫等神经功能丧失 ,30例 ,占 63.8% ; 级 …     

微创穿刺自然引流术与传统钻孔冲洗引流术治疗慢性硬膜下血肿的疗效评价

目的评价微创穿刺自然引流术与传统钴孔冲洗引流术治疗CSDH的疗效。方法选取90倒CSDH患者,随机分为2组,45例采用微刨穿刺术进行治疗（A组）,45例采用传统钻孔冲洗引流术进行治疗（B组）。结果经微创穿刺自然引流术治疗的45例患者（A组）脑受压消失,血肿大部分甚至完全清除;经传统钻孔冲洗引流术治疗的45例患者（B组）,有7倒术后血肿复发,颅内积气4例。结论微创穿刺自然引流术与传统的手术治疗相比,是治疗CSDH的一种更加有效安全、简捷经济的治疗方法。     

The Application of Transcranial Doppler Sonography in Patients with Chronic Subdural Haematoma

Summary  The aim of this study was to evaluate the haemodynamic changes of the middle cerebral artery (MCA) and their clinical significance before and after surgical aspiration in patients with chronic subdural haematoma (CSDH).  Nineteen patients with CSDH (17 unilateral and 2 bilateral) received transcranial Doppler sonography (TCD) examinations for cerebral blood flow velocity (CBFv) of the MCA prior to and 5 days after neurosurgical treatment. A total of 21 lesion and 10 non-lesion hemispheres were included. Cranial computerized tomography (CT) and clinical assessments were performed before and 3 months following surgery.  The preoperative TCD study revealed that the lesion hemisphere had a modest decrease in CBFv in the MCA as compared to the non-lesion hemisphere. Postoperatively, the CBFv significantly improved in the lesion hemisphere, but not in the non-lesion hemisphere, compared to the preoperative data (P<0.005). The improvement in CBFv showed no significant correlation with brain shift and haematoma volume of the initial cranial CT. Additionally, two patients, who were proved to have a postoperative complication of subdural pneumocephalus, failed to attend follow-up examinations of TCD.  Our results support TCD as an alternative follow-up examination for patients with CSDH, although it may not be sensitive enough as a preoperative screening tool. Postoperatively, improvements in the CBFv of the lesion hemisphere are characteristic. An unexplained difficulty of accessing cerebral basal arteries in follow-up TCD examinations should suggest pneumocephalus in the primary differential diagnosis.