Asano Y, Hasuo M, Takahashi I, Shimosawa S
Department of Neurosurgery, Kariya General Hospital, Aichi, Japan.
No To Shinkei. 1992 Dec;44(12):1127-31.
32 cases of traumatic subdural hygroma (TSH) in adults with surgical treatment were retrospectively investigated by means by clinical features and CT findings. The cases consisted of 29 males and 3 females, aged 41 to 87 years (mean 69). Preparative CT scan of all cases revealed low density area and crescent shape in frontotemporal or frontoparietal subdural space. Half of the cases had bilateral lesions. At operation of TSH, color of subdural fluid collections was more water clear or xanthochromic than bloody. As a results, 22 out of 32 cases (69%) in TSH improved with surgical treatment. Many of effective cases of surgical treatment in TSH had short interval from trauma to operation and light disturbance of consciousness before operation. However, the other intracranial damage will also affect the clinical outcome of TSH, because the majority of cases in this study was accompanied by an intracranial damage including cerebral contusion, subarachnoid hemorrhage or intracranial hemorrhage. Nevertheless, surgical management for TSH was so effective that the operation should be undergone sooner interval from trauma, simultaneously considering the another intracranial lesions except TSH. But then, we experienced 7 cases (22%) of ventricular dilatation and 5 cases (16%) of chronic subdural hematoma in postoperative follow up CT scans. In 5 cases among the former, ventriculoperitonial shunt was done, and in 3 cases among the latter, burr hole evacuation was performed. Therefore, the postoperative course of TSH should require careful observation by CT scan and so on.
回顾性研究32例接受手术治疗的成人创伤性硬膜下积液(TSH)患者的临床特征和CT表现。病例包括29例男性和3例女性,年龄41至87岁(平均69岁)。所有病例的术前CT扫描均显示额颞部或额顶部硬膜下间隙有低密度区和新月形。半数病例为双侧病变。TSH手术时,硬膜下积液的颜色多为清亮或淡黄色而非血性。结果,32例TSH患者中有22例(69%)经手术治疗后病情改善。TSH手术治疗的许多有效病例从创伤到手术的间隔时间短,术前意识障碍轻。然而,其他颅内损伤也会影响TSH的临床结局,因为本研究中的大多数病例伴有颅内损伤,包括脑挫伤、蛛网膜下腔出血或颅内出血。尽管如此,TSH的手术治疗非常有效,应在创伤后尽早进行手术,同时考虑除TSH之外的其他颅内病变。但随后,我们在术后随访CT扫描中发现7例(22%)脑室扩张和5例(16%)慢性硬膜下血肿。前者中的5例进行了脑室腹腔分流术,后者中的3例进行了钻孔引流术。因此,TSH的术后病程需要通过CT扫描等进行仔细观察。