Mori K, Maeda M
Department of Neurosurgery, Juntendo University, Izunagaoka Hospital, Tagata-gun, Shizuoka, Japan.
Acta Neurochir (Wien). 2003 Jul;145(7):533-39; discussion 539-40. doi: 10.1007/s00701-003-0026-1.
Chronic subdural haematoma (CSDH) is a rare clinical complication of neurosurgical procedures. CSDH occurs sporadically after aneurysm clipping surgery and revascularisation surgery but the risk factors are not known. The present study reviewed 6613 consecutive neurosurgical procedures performed from January 1987 to July 2001, and identified 621 cases of CSDH. Fifty of these 621 cases had a past history of neurological disorders treated by neurosurgery. This study evaluated these 50 cases in order to elucidate the clinical and radiological characteristics of CSDH after neurosurgery and to investigate the etiology for identifying in the risk factors of CSDH as a postoperative complication. The incidence of CSDH after neurosurgery was 0.8% (50/6613). Twenty-seven of the 50 patients with a past history of neurosurgery had undergone aneurysm clipping surgery. The incidence after clipping surgery was 2.4%. Twelve of these 27 cases also underwent ventriculoperitoneal shunting. Three patients had postoperative CSDH after arachnoid cyst opening and/or shunting. The incidence was highest at 7.5%. Three patients had postoperative CSDH after brain tumour surgery. The incidence was low at 0.4%. However, the ventricular cerebrospinal fluid (CSF) space was opened during tumour removal in 2 of these 3 patients. Communication of the subarachnoid space to the subdural space is considered to be one of the causative factors and excessive CSF shunting facilitates formation of CSDH after neurological surgery. Repair of arachnoid tearing during neurosurgery and avoidance of excessive CSF shunting may reduce the risk of CSDH after neurosurgery.
慢性硬膜下血肿（CSDH）是神经外科手术中一种罕见的临床并发症。CSDH在动脉瘤夹闭手术和血管重建手术后偶有发生，但危险因素尚不清楚。本研究回顾了1987年1月至2001年7月连续进行的6613例神经外科手术，并确定了621例CSDH病例。这621例病例中有50例有神经外科治疗的既往神经疾病史。本研究对这50例病例进行评估，以阐明神经外科手术后CSDH的临床和影像学特征，并调查病因，以确定CSDH作为术后并发症的危险因素。神经外科手术后CSDH的发生率为0.8%（50/6613）。50例有神经外科手术史的患者中有27例接受了动脉瘤夹闭手术。夹闭手术后的发生率为2.4%。这27例病例中有12例还接受了脑室腹腔分流术。3例患者在蛛网膜囊肿开放和/或分流术后发生了术后CSDH。发生率最高，为7.5%。3例患者在脑肿瘤手术后发生了术后CSDH。发生率较低，为0.4%。然而，这3例患者中有2例在肿瘤切除过程中打开了脑室脑脊液（CSF）间隙。蛛网膜下腔与硬膜下腔的连通被认为是致病因素之一，过度的CSF分流会促进神经外科手术后CSDH的形成。神经外科手术中修复蛛网膜撕裂并避免过度的CSF分流可能会降低神经外科手术后CSDH的风险。
