Kon Hiroyuki, Saito Atsushi, Uchida Hiroki, Inoue Mizuho, Sasaki Tatsuya, Nishijima Michiharu
Department of Neurosurgery, Aomori Prefectural Central Hospital, Aomori, Japan.
Case Rep Neurol. 2014 Jan 18;5(3):208-13. doi: 10.1159/000357367. eCollection 2013 Sep.
Traumatic acute subdural hematoma (ASDH) is generally addressed by craniotomy under general anesthesia. We report a patient whose traumatic ASDH was treated under local anesthesia by one-burr-hole endoscopic surgery. This 87-year-old woman had undergone coil embolization for a ruptured right middle-cerebral artery aneurysm and placement of a ventriculoperitoneal shunt for normal pressure hydrocephalus 5 years earlier. Upon admission, she manifested consciousness disturbance after suffering head trauma and right hemiplegia. Her Glasgow Coma Scale score was 8 (E2V2M4). Computed tomography (CT) demonstrated a thick, left-frontotemporal ASDH. Due to her advanced age and poor condition, we performed endoscopic surgery rather than craniotomy to evacuate the ASDH. Under local anesthesia, we made a burr hole in her left forehead and increased its size to 15 mm in diameter. After introducing a transparent sheath into the hematoma cavity with a rigid endoscope, the clot was evacuated with a suction tube. The arterial bleeding point was electrically coagulated. A postoperative CT scan confirmed the reduction of the hematoma. There was neither brain compression nor brain swelling. Her consciousness disturbance and right hemiplegia improved immediately. Endoscopic surgery may represent a viable method to address traumatic intracranial hematomas in some patients.
创伤性急性硬膜下血肿（ASDH）通常在全身麻醉下通过开颅手术治疗。我们报告了一例通过单钻孔内镜手术在局部麻醉下治疗创伤性ASDH的患者。这位87岁的女性5年前因右侧大脑中动脉动脉瘤破裂接受了弹簧圈栓塞治疗，并因正常压力脑积水放置了脑室腹腔分流管。入院时，她在头部受伤后出现意识障碍和右侧偏瘫。她的格拉斯哥昏迷量表评分为8分（E2V2M4）。计算机断层扫描（CT）显示左侧额颞部有一个厚的ASDH。由于她年龄较大且病情较差，我们进行了内镜手术而非开颅手术来清除ASDH。在局部麻醉下，我们在她的左前额钻了一个孔，并将其扩大到直径15毫米。用硬式内镜将透明鞘管插入血肿腔后，用吸管吸出凝血块。对动脉出血点进行电凝。术后CT扫描证实血肿缩小。既没有脑受压也没有脑肿胀。她的意识障碍和右侧偏瘫立即得到改善。内镜手术可能是治疗某些患者创伤性颅内血肿的一种可行方法。
