Tosaka Masahiko, Sakamoto Kazuya, Watanabe Saiko, Yodonawa Masahiko, Kunimine Hideo, Aishima Kaoru, Fujii Takashi, Yoshimoto Yuhei
Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan.
Neurol Med Chir (Tokyo). 2013;53(4):273-8. doi: 10.2176/nmc.53.273.
Chronic subdural hematoma (CSDH) is generally treated by twist drill, and one and two burr-hole craniostomy. We proposed new classification of the intraoperative condition of CSDH, and present a safer technique for aspiration of CSDH in one burr-hole surgery. The intraoperative condition of CSDH was classified according to the connections between the hematoma cavity and the extracranial space as follows. The "closed condition" represents only a single route consisting of a tube inserted intraoperatively connecting the extracranial space to the hematoma cavity. The "open condition" includes another route or space, which can freely pass air, saline, or old hematoma fluid, in addition to the tube inserted intraoperatively. Twist drill craniostomy and two burr-hole craniostomy clearly involve the intraoperative closed and open conditions, respectively. One burr-hole craniostomy may involve either condition due to the operative procedure. Aspiration and irrigation of the hematoma is basically free and safe in the open condition, but risky in the closed condition. All of the hematoma can be aspirated through one burr hole under certain open conditions with temporary replacement of the hematoma cavity with air followed by replacement of air with saline. Twenty-seven patients with symptomatic CSDH underwent one burr-hole craniostomy by the above mentioned aspiration technique. There were no special complications. The recurrence rate was average. The substitution of saline after complete aspiration of hematoma carries little risk only under the "open condition," shortens the operation time, and achieves good irrigation of the hematoma.
慢性硬膜下血肿（CSDH）通常采用钻孔引流术以及单孔和双孔开颅术进行治疗。我们提出了CSDH术中情况的新分类方法，并介绍了一种在单孔手术中更安全地抽吸CSDH的技术。CSDH的术中情况根据血肿腔与颅外间隙之间的连通情况分为以下几类。“封闭情况”是指仅存在一条由术中插入的连接颅外间隙与血肿腔的管道构成的单一通路。“开放情况”除了术中插入的管道外，还包括另一条可使空气、盐水或陈旧性血肿液自由通过的通路或空间。钻孔开颅术和双孔开颅术分别明显涉及术中的封闭和开放情况。单孔开颅术由于手术操作的原因可能涉及这两种情况中的任何一种。在开放情况下，血肿的抽吸和冲洗基本是安全的，但在封闭情况下则有风险。在某些开放情况下，通过单孔可抽吸所有血肿，方法是先用空气临时置换血肿腔，然后再用盐水置换空气。27例有症状的CSDH患者通过上述抽吸技术接受了单孔开颅术。未出现特殊并发症。复发率为平均水平。仅在“开放情况”下，血肿完全抽吸后用盐水置换风险很小，可缩短手术时间，并能对血肿进行良好冲洗。
