Cooper P R, Rovit R L, Ransohoff J
Surg Neurol. 1976 Jan;5(1):25-8.
Although acute subdural hematoma continues to be one of the more common conditions neurosurgeons are called upon to treat, mortality rates continue to be quite unsatisfactory. Hemicraniectomy with wide decompression of the swollen brain was devised for the condition in 1971 (JNS 34:70-76). Initial results were quite encouraging with a 40% overall survival rate, 28% of the patients returning to normal activity. Since this original report, an additional 50 patients have been treated with only a 10% total survival rate and a 4% functional survival rate. Retrospective analysis of our cases over the past three years reveals that patient's age, status of preoperative neurologic examination, angiographic findings and appearance of the brain at operation, all have no statistical correlation with survival. These statistics will be presented and discussed. The failure of hemicraniectomy and extensive clot removal to significantly increase the functional survival rate in this condition implies that in a majority of patients with "acute subdural hematoma," primary brain stem and possibly subcortical injury are present, neither of which is amenable to radical therapy. The operation of hemicraniectomy should be restricted to those patients who enter hospital, obtunded but without demonstrable brain stem dysfunctionn, only to deteriorate subsequently because of increasing hemispheric edema and/or subdural clot.
尽管急性硬膜下血肿仍然是神经外科医生需要治疗的较为常见的病症之一，但其死亡率一直相当不尽人意。1971年（《神经外科杂志》34:70 - 76）针对这种病症设计了大脑半球切除术及对肿胀大脑进行广泛减压术。最初的结果相当令人鼓舞，总体生存率为40%，28%的患者恢复正常活动。自这份最初的报告以来，又有50例患者接受了治疗，总生存率仅为10%，功能生存率为4%。对我们过去三年病例的回顾性分析显示，患者的年龄、术前神经学检查状况、血管造影结果以及手术时大脑的外观，均与生存率无统计学关联。这些统计数据将予以呈现并讨论。大脑半球切除术及广泛清除血肿未能显著提高这种病症的功能生存率，这意味着在大多数“急性硬膜下血肿”患者中，存在原发性脑干损伤以及可能的皮质下损伤，而这两者均无法通过根治性治疗解决。大脑半球切除术应仅限于那些入院时意识迟钝但无明显脑干功能障碍、随后因半球水肿和/或硬膜下血肿增加而病情恶化的患者。
