Sato M, Iwatsuki K, Akiyama C, Kumura E, Yoshimine T
Department of Neurosurgery, Toyonaka Municipal Hospital, Japan.
Neurosurgery. 2001 Jun;48(6):1297-301. doi: 10.1097/00006123-200106000-00023.
Recurrence of chronic subdural hematoma is not rare. Among patients who experience recurrence, severe background disease may adversely influence the prognosis of chronic subdural hematoma. We treated patients with these refractory hematomas with an Ommaya cerebrospinal fluid (CSF) reservoir and analyzed the effectiveness of the treatment.
Sixteen patients with refractory chronic subdural hematoma were studied. These patients had severe diseases that adversely influenced the clinical course of chronic subdural hematoma, including cerebral infarction, liver cirrhosis, thrombocytopenia, severe Parkinsonism, severe heart disease, psychiatric disease, and spinocerebellar degeneration. All patients were treated initially in the standard fashion: evacuation of the hematoma followed by irrigation and drainage of the hematoma cavity. In each patient, an Ommaya CSF reservoir was implanted after the hematoma recurred. Whenever the volume of the hematoma either decreased very slowly or increased, the reservoir was punctured.
The hematoma size decreased to less than 3 mm a median of 60 days after introduction of the reservoir. Postoperatively, 13 patients returned to their condition before the onset of hematoma. One patient died of myocardial infarction, and two patients with Parkinson's disease could not maintain their previous functional level; both remained in a partially dependent state. Complications consisted of minor bleeding in two patients and occlusion of the reservoir in two other patients.
By use of this method, reoperation was avoided and the patients were mobile early in the postoperative period. This method was suitable for refractory chronic subdural hematoma accompanied by severe disease that adversely influenced the clinical course.
慢性硬膜下血肿的复发并不罕见。在经历复发的患者中，严重的基础疾病可能会对慢性硬膜下血肿的预后产生不利影响。我们使用Ommaya脑脊液（CSF）储液囊治疗这些难治性血肿，并分析了治疗效果。
对16例难治性慢性硬膜下血肿患者进行了研究。这些患者患有严重疾病，对慢性硬膜下血肿的临床病程产生不利影响，包括脑梗死、肝硬化、血小板减少、严重帕金森病、严重心脏病、精神疾病和脊髓小脑变性。所有患者最初均采用标准方式治疗：血肿清除术，随后对血肿腔进行冲洗和引流。在每位患者血肿复发后植入Ommaya CSF储液囊。每当血肿体积减小非常缓慢或增大时，就对储液囊进行穿刺。
引入储液囊后，血肿大小在中位60天后减小至小于3 mm。术后，13例患者恢复到血肿发作前的状态。1例患者死于心肌梗死，2例帕金森病患者无法维持其先前的功能水平；两人均处于部分依赖状态。并发症包括2例患者出现轻微出血，另外2例患者储液囊堵塞。
通过使用这种方法，避免了再次手术，患者在术后早期即可活动。这种方法适用于伴有严重疾病且对临床病程产生不利影响的难治性慢性硬膜下血肿。
