Weigel R, Krauss J K, Schmiedek P
Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany.
Br J Neurosurg. 2004 Feb;18(1):8-18. doi: 10.1080/02688690410001660418.
The history of chronic subdural haematoma (CSH), spanning from its possibly earliest beginnings throughout the centuries until the early 1980s, was investigated within the context of four different epochs. In the 'era of uncertainty', successful trephination, the modem method of choice for the treatment of CSH, was developed by neolithic men. Various historical sources indicate that patients with CSH might have undergone surgery at that time. CSH might have been one of the ailments that had spectacular courses of salvation after trephination. The entity of CSH was first described in the 'era of pioneers' in the seventeenth century by Johann Jacob Wepfer. The misconception of 'pachymeningitis hemorrhagica interna' was introduced by Rudolf Virchow in 1857. By the end of the nineteenth century it became more widely accepted that trauma was a possible cause of CSH. Successful neurosurgical treatment of CSH was first reported by Hulke in 1883. Putnam and Cushing, in 1925, focused on surgery as the treatment of choice for CSH. In the 'era of diagnostic refinement', the introduction of pneumencephalography and angiography allowed the diagnosis of CSH much earlier. Subsequently, the typical signs and symptoms of patients suffering from CSH changed from apathy and coma to headaches and discrete focal neurological symptoms. In the 'era of surgical routine', neurosurgical approaches became smaller and less invasive. Removal of the haematoma was identified as the primary goal of surgery. The use of closed system drainage markedly improved reexpansion of the brain after surgery. Burr hole craniostomy and twist drill craniostomy became the surgical treatment of first choice because of their low morbidity and mortality. There is growing evidence, however, that the neurosurgical learning curve has reached a plateau.
本文在四个不同时期的背景下，研究了慢性硬膜下血肿（CSH）从可能最早出现直至20世纪80年代初的历史。在“不确定时代”，成功的环钻术，即现代治疗CSH的首选方法，由新石器时代的人类发明。各种历史资料表明，当时患有CSH的患者可能已经接受了手术。CSH可能是环钻术后有显著康复过程的疾病之一。CSH的实体在17世纪的“先驱时代”由约翰·雅各布·韦普费尔首次描述。1857年，鲁道夫·菲尔绍引入了“内出血性硬脑膜炎”的错误概念。到19世纪末，创伤是CSH的可能病因这一观点得到了更广泛的认可。1883年，胡尔克首次报道了CSH的成功神经外科治疗。1925年，普特南和库欣将手术作为CSH的首选治疗方法。在“诊断细化时代”，气脑造影和血管造影的引入使CSH的诊断更早。随后，CSH患者的典型体征和症状从冷漠和昏迷转变为头痛和离散的局灶性神经症状。在“手术常规时代”，神经外科手术方法变得更小且侵入性更低。清除血肿被确定为手术的主要目标。闭式引流系统的使用显著改善了术后大脑的再扩张。钻孔开颅术和锥颅术因其低发病率和死亡率而成为首选的手术治疗方法。然而，越来越多的证据表明，神经外科的学习曲线已达到平稳状态。
