Pang Chang Hwan, Lee Soo Eon, Kim Chang Hyeun, Kim Jeong Eun, Kang Hyun-Seung, Park Chul-Kee, Paek Sun Ha, Kim Chi Heon, Jahng Tae-Ahn, Kim Jin Wook, Kim Yong Hwy, Kim Dong Gyu, Chung Chun Kee, Jung Hee-Won, Yoo Heon
Department of Neurosurgery, Seoul National University Hospital;
Department of Neurosurgery, Seoul National University College of Medicine; and.
J Neurosurg. 2015 Jul;123(1):65-74. doi: 10.3171/2014.12.JNS141189. Epub 2015 Feb 13.
There is inconsistency among the perioperative management strategies currently used for chronic subdural hematoma (cSDH). Moreover, postoperative complications such as acute intracranial bleeding and cSDH recurrence affect clinical outcome of cSDH surgery. This study evaluated the risk factors associated with acute intracranial bleeding and cSDH recurrence and identified an effective perioperative strategy for cSDH patients.
A retrospective study of patients who underwent bur hole craniostomy for cSDH between 2008 and 2012 was performed.
A consecutive series of 303 cSDH patients (234 males and 69 females; mean age 67.17 years) was analyzed. Postoperative acute intracranial bleeding developed in 14 patients (4.57%) within a mean of 3.07 days and recurrence was observed in 37 patients (12.21%) within a mean of 31.69 days (range 10-104 days) after initial bur hole craniostomy. The comorbidities of hematological disease and prior shunt surgery were clinical factors associated with acute bleeding. There was a significant risk of recurrence in patients with diabetes mellitus, but recurrence did not affect the final neurological outcome (p = 0.776). Surgical details, including the number of operative bur holes, saline irrigation of the hematoma cavity, use of a drain, and type of postoperative ambulation, were not significantly associated with outcome. However, a large amount of drainage was associated with postoperative acute bleeding.
Bur hole craniostomy is an effective surgical procedure for initial and recurrent cSDH. Patients with hematological disease or a history of prior shunt surgery are at risk for postoperative acute bleeding; therefore, these patients should be carefully monitored to avoid overdrainage. Surgeons should consider informing patients with diabetes mellitus that this comorbidity is associated with an increased likelihood of recurrence.
目前用于慢性硬膜下血肿（cSDH）的围手术期管理策略存在不一致性。此外，术后并发症如急性颅内出血和cSDH复发会影响cSDH手术的临床结局。本研究评估了与急性颅内出血和cSDH复发相关的危险因素，并确定了一种针对cSDH患者有效的围手术期策略。
对2008年至2012年间接受钻孔开颅术治疗cSDH的患者进行回顾性研究。
分析了连续的303例cSDH患者（男性234例，女性69例；平均年龄67.17岁）。术后14例患者（4.57%）在平均3.07天内发生急性颅内出血，37例患者（12.21%）在初次钻孔开颅术后平均31.69天（范围10 - 104天）内出现复发。血液系统疾病和既往分流手术的合并症是与急性出血相关的临床因素。糖尿病患者有显著的复发风险，但复发并不影响最终的神经功能结局（p = 0.776）。手术细节，包括手术钻孔数量、血肿腔生理盐水冲洗、引流管使用和术后活动类型，与结局无显著相关性。然而，大量引流与术后急性出血相关。
钻孔开颅术是治疗初发和复发性cSDH的有效手术方法。患有血液系统疾病或有既往分流手术史的患者术后有急性出血风险；因此，应对这些患者进行仔细监测以避免过度引流。外科医生应考虑告知糖尿病患者，这种合并症与复发可能性增加有关。
