应用神经内镜行钻孔引流术治疗慢性硬膜下血肿

目的：应用神经内镜行钻孔引流术治疗慢性硬膜下血肿（CSDH），防止颅内积气及血肿复发。方法全身麻醉后，根据 CT 片定好钻孔位，横行作长约3~4 cm 皮肤切口，钻孔并扩大骨孔至直径1.5 cm，切开硬膜及血肿包膜，并悬吊于骨窗四周给予电凝止血。应用神经内镜通过钻孔处进入血肿腔，一边清除血肿一边观察，处理血肿腔的纤维分隔和出血点等问题，最后在内镜直视下置入引流管于血肿最前端作外引流。结果本组63例 CSDH 均在神经内镜下钻孔引流，全部治愈。术中见11例血肿腔内有絮状物和血块，给予清除，术后复查 CT 未见1例血肿腔内积气，8例有少量积液，随访3个月无血肿复发。结论在神经内镜下行 CSDH 钻孔引流术，安全可靠，侵袭性小，可以达到血肿引流充分和防止颅内积气及血肿复发的目的。

Application of neuroendoscopy in trepanation and drainage to treat chronic subdural hematoma

Objective To introduce neuroendoscopy to the drilling drainage of chronic subdural haematoma（CSDH）,and evaluate its effect in prevention of pneumocephalus and hematoma recurrence. Methods In addition to the traditional operation procedure,neuroendoscopy was inserted into the cavity of the CSDH,the hematoma was removed,the fibers are separated and bleeding was coagulated under endoscopy. Finally,an external drainage tube was placed in the forefront of the cavity under direct endoscopic vision. Results 63 CSDH patients were operated with the application of neuroendoscopy,all of them were cured. Fiber partitions and blood clots were found and cleared in the cavity of 11 patients. Postoperative CT scan showed no pneumocephalus,8 patients with little subdural effusion. No recurrence was found in 3-month follow up. Conclusion Application of neuroendoscopy in drilling drainage is a safe, reliable and minimally invasive surgery to treat chronic subdural hematoma. It can fully drain the hematoma, prevent pneumocephalus and hematoma recurrence.