急性硬膜外血肿的手术治疗

Surgical management of acute epidural hematomas.

作者信息

Bullock M Ross, Chesnut Randall, Ghajar Jamshid, Gordon David, Hartl Roger, Newell David W, Servadei Franco, Walters Beverly C, Wilberger Jack E

机构信息

Department of Neurological Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.

出版信息

Neurosurgery. 2006 Mar;58(3 Suppl):S7-15; discussion Si-iv.

PMID:16710967

Abstract

INDICATIONS FOR SURGERY

An epidural hematoma (EDH) greater than 30 cm3 should be surgically evacuated regardless of the patient's Glasgow Coma Scale (GCS) score. An EDH less than 30 cm3 and with less than a 15-mm thickness and with less than a 5-mm midline shift (MLS) in patients with a GCS score greater than 8 without focal deficit can be managed nonoperatively with serial computed tomographic (CT) scanning and close neurological observation in a neurosurgical center.

TIMING

It is strongly recommended that patients with an acute EDH in coma (GCS score < 9) with anisocoria undergo surgical evacuation as soon as possible.

METHODS

There are insufficient data to support one surgical treatment method. However, craniotomy provides a more complete evacuation of the hematoma.

摘要

手术指征

硬膜外血肿（EDH）体积大于30 cm³，无论患者的格拉斯哥昏迷量表（GCS）评分如何，均应进行手术清除血肿。对于GCS评分大于8且无局灶性神经功能缺损的患者，若EDH体积小于30 cm³、厚度小于15 mm且中线移位（MLS）小于5 mm，可在神经外科中心通过连续计算机断层扫描（CT）及密切神经学观察进行非手术治疗。