Brokinkel Benjamin, Ewelt Christian, Holling Markus, Hesselmann Volker, Heindel Walter Leonard, Stummer Walter, Fischer Bernhard Robert
University Hospital Muenster, Department of Neurosurgery, Muenster, Germany.
Turk Neurosurg. 2013;23(4):458-63. doi: 10.5137/1019-5149.JTN.7269-12.0.
To evaluate timing of scheduled CT-scans after burr hole trepanation for chronic subdural hematoma (cSDH).
131 patients with primary cSDH were included. Scheduled CT-scans were performed after burr hole trepanation and placement of a subdural drain. The influence of CT-scanning with or without indwelling drain was analysed regarding subsequent surgery and CT-scans, duration of hospitalization, short- and middle-term follow up by single factor analyses. Subgroup analyses were performed for patients receiving anticoagulant drugs.
Median age was 74 years. Routine CT-scans with indwelling drainage were not shown to be beneficial regarding subsequent burr hole trepanations (p=0.243), craniotomies (p=1.000) and outcome at discharge (p=0.297). Mean duration of hospitalization (11 vs. 8 days, p=0.013) was significantly longer and number of subsequent CT-scans was higher when CT scan was performed with indwelling drain (2.3 vs. 1.4, p=0.001). In middle-term follow-up, beneficial effects of CT-scanning with inlaying drainage could neither be shown. Moreover, advantageous effects of CT-scans with indwelling drains could neither be shown for patients receiving anticoagulant drugs.
Scheduled postoperative cranial imaging with indwelling drains was not shown to be beneficial and misses information of intracranial damage inflicted by removal of drains. We thus recommend CT-scanning after drainage removal.
评估慢性硬膜下血肿（cSDH）钻孔引流术后定期进行CT扫描的时机。
纳入131例原发性cSDH患者。在钻孔引流及放置硬膜下引流管后进行定期CT扫描。通过单因素分析，分析有无留置引流管时CT扫描对后续手术、CT扫描、住院时间、短期及中期随访的影响。对接受抗凝药物治疗的患者进行亚组分析。
中位年龄为74岁。对于后续钻孔引流术（p = 0.243）、开颅手术（p = 1.000）及出院时的预后（p = 0.297），留置引流管时进行常规CT扫描未显示出益处。当进行CT扫描时留置引流管，平均住院时间显著更长（11天对8天，p = 0.013），且后续CT扫描次数更多（2.3次对1.4次，p = 0.001）。在中期随访中，留置引流管时进行CT扫描也未显示出有益效果。此外，对于接受抗凝药物治疗的患者，留置引流管时进行CT扫描也未显示出有益效果。
留置引流管时进行术后定期颅脑成像未显示出益处，且遗漏了拔除引流管所致颅内损伤的信息。因此，我们建议在拔除引流管后进行CT扫描。
