Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
World Neurosurg. 2011 Jan;75(1):73-7. doi: 10.1016/j.wneu.2010.10.021.
This report presents 12 consecutively managed patients with aneurysmal subarachnoid hemorrhage (SAH) associated with acute subdural hematoma (ASDH) who underwent decompressive craniectomy (DC) with special attention to their clinical characteristics and surgical outcomes.
We retrospectively reviewed medical charts, radiologic findings, surgical notes, and video records.
Among these 12 patients (mean age 59.1 years, 4 men, 8 women), the Hunt and Kosnik clinical grade was grade V in 7 patients (58.3%), grade IV in 2 patients (16.7%), grade III in 2 patients (16.7%), and grade II in 1 patient (8.3%). The aneurysms were located on the internal carotid artery in four patients, the middle cerebral artery in six patients, and the anterior communicating artery in two patients. Computed tomography findings on admission revealed ASDH in all patients. In addition, SAH was seen in 11 patients. An intracerebral hematoma was found in eight patients, intraventricular hemorrhaging occurred in four, and an acute hydrocephalus was seen in one patient. All patients underwent a microsurgical clipping procedure and an additional DC. Symptomatic vasospasm was confirmed in six (50%), and eight patients with chronic hydrocephalus received a ventriculoperitoneal shunt (67%). The Glasgow Outcome Scale at discharge showed good recovery in five patients (41.7%), severe disability in four (33.3%), vegetative state in two (16.7%), and death in one patient (8.3%). A favorable outcome was achieved in five patients (41.7%).
We suggest that the DC was effective for reducing morbidity and mortality in poor grade patients with SAH presenting with ASDH.
本报告介绍了 12 例连续接受治疗的伴有急性硬膜下血肿（ASDH）的蛛网膜下腔出血（SAH）患者，他们接受了去骨瓣减压术（DC），特别关注其临床特征和手术结果。
我们回顾性地审查了病历、影像学发现、手术记录和视频记录。
在这 12 名患者中（平均年龄 59.1 岁，4 名男性，8 名女性），Hunt 和 Kosnik 临床分级为 5 级的有 7 例（58.3%），4 级的有 2 例（16.7%），3 级的有 2 例（16.7%），2 级的有 1 例（8.3%）。动脉瘤位于颈内动脉 4 例，大脑中动脉 6 例，前交通动脉 2 例。入院时的 CT 发现所有患者均有 ASDH。此外，11 例患者有 SAH。8 例患者有脑内血肿，4 例患者有脑室内出血，1 例患者有急性脑积水。所有患者均行显微镜下夹闭术和附加的 DC。6 例（50%）患者确诊为症状性血管痉挛，8 例慢性脑积水患者行脑室-腹腔分流术（67%）。出院时的格拉斯哥结局量表显示，5 例（41.7%）患者恢复良好，4 例（33.3%）患者严重残疾，2 例（16.7%）患者处于植物状态，1 例（8.3%）患者死亡。5 例（41.7%）患者预后良好。
我们认为，对于伴有 ASDH 的 SAH 患者，DC 可有效降低中低分级患者的发病率和死亡率。
