Ogasawara K, Koshu K, Yoshimoto T, Ogawa A
Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
Neurosurgery. 1999 Sep;45(3):484-8; discussion 488-9. doi: 10.1097/00006123-199909000-00014.
Intracerebral hemorrhage occurring after removal of a chronic subdural hematoma (CSH) is a rare but usually devastating postoperative complication. In patients with CSH, we determined cerebral blood flow immediately after surgical decompression to clarify the pathogenic mechanism of this complication.
In 22 patients with unilateral CSH, a catheter was inserted into the hematoma cavity through a single burr hole without leakage of the contents. Cerebral blood flow was measured using single-photon emission computed tomography 1 day before surgery, immediately after rapid decompression by opening the catheter, and 3 days after surgery.
Single-photon emission computed tomography imaging immediately after decompression demonstrated areas of hyperemia in nine patients (41%). In all nine patients, hyperemia was observed in the cortex beneath the CSH, and it disappeared on the 3rd postoperative day. The patients with hyperemia were significantly older than those without hyperemia. Other variables, including preoperative cerebral blood flow, intrahematoma pressure before decompression, and mean arterial blood pressure during decompression had no significant effect on the occurrence of hyperemia.
In elderly patients, rapid decompression of CSH frequently results in transient hyperemia in the cerebral cortex beneath the hematoma.
慢性硬膜下血肿（CSH）清除术后发生的脑出血是一种罕见但通常具有毁灭性的术后并发症。在CSH患者中，我们在手术减压后立即测定脑血流量，以阐明该并发症的发病机制。
在22例单侧CSH患者中，通过单个钻孔将导管插入血肿腔，而不使内容物漏出。在手术前1天、通过打开导管快速减压后立即以及手术后3天，使用单光子发射计算机断层扫描测量脑血流量。
减压后立即进行的单光子发射计算机断层扫描成像显示9例患者（41%）存在充血区域。在所有9例患者中，在CSH下方的皮质中观察到充血，并且在术后第3天消失。充血患者的年龄显著大于无充血患者。其他变量，包括术前脑血流量、减压前血肿内压力以及减压期间的平均动脉血压，对充血的发生没有显著影响。
在老年患者中，CSH的快速减压经常导致血肿下方脑皮质的短暂充血。
