手术治疗慢性硬脑膜下血肿318例

目的　探讨慢性硬脑膜下血肿的手术治疗方法。　方法　回顾性分析 318例慢性硬脑膜下血肿 (CSDH)病人的临床特点、神经影像学资料、手术方法和结果。　结果　 318例病人首次手术均采用颅骨钻孔冲洗并闭式引流术 ,仅 37例血肿复发后需再次手术处理 ,其中 33例接受骨瓣开颅血肿及包膜清除术或内窥镜手术后痊愈 ,另 4例老年脑萎缩病人在再次手术前死于伴随疾病。　结论　颅骨钻孔冲洗并闭式引流术是治疗CSDH的首选方法 ,即使对术前发现血肿包膜增厚者亦适用。骨瓣开颅血肿及包膜清除术适用于血肿壁坚厚、脑萎缩致脑膨起困难者及分隔型血肿等情况。对分隔型血肿 ,内窥镜手术可替代常规开颅术。

Chronic subdural hematoma: surgical management in 318 patients

Objective To explore surgical methods for chronic subdural hematoma (CSDH). Methods Clinical features, neuroradiological material, surgical techniques and outcome of 318 patients with CSDH were analyzed retrospectively. Results Out of the 318 patients who had been initially treated by burr hole craniotomy with closed drainage, only 37 showed recurrence of subdural hematoma with the necessity of reoperation. Except 4 old patients with brain atrophy who died of accompanying diseases, the other 33 all survived larger craniotomy or endoscopic surgery and CSDH subsided finally. Conclusions Burr hole craniotomy with closed drainage should be the first choice for the initial treatment of CSDH, even in cases with preoperative detection of thick neomembrane. Craniotomy should be carried out only in patients with subdural hematoma recurring due to residual thick,tough hematoma membranes or brain atrophy to prevent reexpansion of the brain or septated hematoma. Endoscopic surgery is a good therapeutic alternative of the craniotomy-membranectomy technique for septated hematoma.