Matsuno Akira, Katayama Haruko, Wada Hiromi, Morikawa Kentaro, Tanaka Kotaro, Tanaka Hideki, Murakami Mineko, Fuke Nobuo, Nagashima Tadashi
Department of Neurosurgery, Teikyo University Ichihara Hospital, 3426 Anegasaki, Ichihara City, Chiba 299-0111, Japan.
Surg Neurol. 2003 Jul;60(1):23-30; discussion 30. doi: 10.1016/s0090-3019(03)00023-5.
Although rare, patients with acute subdural hematoma (ASDH) because of severe head injury can develop contralateral acute epi- or subdural hematoma, requiring consecutive surgical procedures. The choice of treatment strategies for such patients is clinically important.
Among 88 patients with ASDH who were surgically treated over 13 years, we encountered and studied 5 patients who developed contralateral acute epi- or subdural hematoma (5.7%).
All 5 patients were male, ranging in age from 17 to 40. According to the Glasgow Coma Scale on admission, 1 patient was rated 3, 1 was 4, 1 was 5, and 2 were 6. All patients underwent consecutive surgical procedures for ASDH and contralateral ASDH and/or acute epidural hematoma, and were given postoperative supportive therapy with barbiturates and mild hypothermia. Patients' outcomes according to the Glasgow Outcome Scale were as follows: 1 patient, good recovery (20.0%); 1, mild disability (20.0%); 2, severe disability (40.0%), and 1, persistent vegetative state (20.0%). No patients died. Although decompressive craniectomy and evacuation of hematoma may lead to contralateral acute epi- or subdural hematoma in patients with ASDH, this therapy is justified because hematoma irrigation with trephination therapy has a poor outcome for comatose patients.
Awareness of intraoperative brain swelling is important, as it suggests the development of contralateral hematoma. Immediate computed tomography and a rapid return to the operating room are therefore critical.
尽管罕见，但因严重颅脑损伤导致急性硬膜下血肿（ASDH）的患者可能会出现对侧急性硬膜外或硬膜下血肿，需要连续进行手术。对于此类患者，治疗策略的选择具有重要的临床意义。
在13年期间接受手术治疗的88例ASDH患者中，我们遇到并研究了5例出现对侧急性硬膜外或硬膜下血肿的患者（5.7%）。
所有5例患者均为男性，年龄在17至40岁之间。根据入院时的格拉斯哥昏迷量表评分，1例患者评分为3分，1例为4分，1例为5分，2例为6分。所有患者均因ASDH和对侧ASDH及/或急性硬膜外血肿接受了连续手术，并在术后接受了巴比妥类药物和轻度低温的支持治疗。根据格拉斯哥预后量表，患者的预后如下：1例患者恢复良好（20.0%）；1例轻度残疾（20.0%）；2例重度残疾（40.0%），1例持续性植物状态（20.0%）。无患者死亡。尽管减压性颅骨切除术和血肿清除术可能会导致ASDH患者出现对侧急性硬膜外或硬膜下血肿，但这种治疗方法是合理的，因为钻孔引流治疗血肿冲洗对昏迷患者的预后较差。
术中意识到脑肿胀很重要，因为这提示对侧血肿的发生。因此，立即进行计算机断层扫描并迅速返回手术室至关重要。
