Tanikawa M, Mase M, Yamada K, Yamashita N, Matsumoto T, Banno T, Miyati T
Department of Neurosurgery, Nagoya City University School of Medicine, Nagoya, Japan.
Acta Neurochir (Wien). 2001;143(6):613-618; discussion 618-9. doi: 10.1007/s007010170067.
To determine the optimal surgical management of chronic subdural hematoma (CSDH), we assessed which operative procedure, burr holes or small craniotomy, was more effective on 49 consecutive patients.
We retrospectively classified all cases into two groups according to the intrahematomal membrane structure of CSDH on T2*-weighted magnetic resonance (MR) imaging. The first group, labeled type B, included hematomas which had no intrahematomal membrane and/or were monolayer multilobule. The second group, labeled type C, consisted of hematomas which were divided into multiple layers by the intrahematomal membrane.
The outcome of type C patients treated with burr holes was significantly inferior to that of those who underwent a small craniotomy in terms of the relative outcome of neurological grading. re-operation ratio, and postoperative hospital stay (p < 0.05). Type C hematomas treated with burr holes also had inferior outcome compared with a small craniotomy in terms of the duration of hematoma until disappearance on postoperative CT (p < 0.05).
We concluded that a considerable number of cases appeared to need craniotomy and resection of intrahematomal membrane for complete recovery in CSDH, and that T2*-weighted MR imaging could be used as a basis for selecting the operative procedure for CSDH.
为确定慢性硬膜下血肿（CSDH）的最佳手术治疗方法，我们评估了连续49例患者采用钻孔引流术或小骨瓣开颅术哪种手术方式更有效。
我们根据T2 *加权磁共振（MR）成像上CSDH的血肿内隔膜结构将所有病例回顾性地分为两组。第一组标记为B型，包括无血肿内隔膜和/或为单层多小叶的血肿。第二组标记为C型，由被血肿内隔膜分成多层的血肿组成。
就神经功能分级的相对结果、再次手术率和术后住院时间而言，钻孔引流术治疗的C型患者的结果明显低于接受小骨瓣开颅术的患者（p < 0.05）。就术后CT上血肿消失前的持续时间而言，钻孔引流术治疗的C型血肿与小骨瓣开颅术相比结果也较差（p < 0.05）。
我们得出结论，相当数量的CSDH病例似乎需要开颅并切除血肿内隔膜才能完全康复，并且T2 *加权MR成像可作为选择CSDH手术方式的依据。
