Yokosuka Kimihiko, Uno Masaaki, Matsumura Kohei, Takai Hiroki, Hagino Hirotaka, Matsushita Nobuhisa, Toi Hiroyuki, Matsubara Shunji
Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan.
J Neurosurg. 2015 Oct;123(4):1065-9. doi: 10.3171/2014.10.JNS14915. Epub 2015 Apr 24.
Endoscopic surgery was performed for acute or subacute subdural hematoma (SDH), and its effectiveness and safety in elderly patients were evaluated.
Between September 2007 and November 2013, endoscopic surgery was performed in 11 elderly patients with acute SDH (8 patients) and subacute SDH (3 patients). The criteria for surgery were as follows: 1) the presence of clinical symptoms; 2) age older than 70 years; 3) no brain injury (intracerebral hematoma, brain contusion); 4) absence of an enlarging SDH; and 5) no high risk of bleeding. Hematoma evacuation was performed with a 4-mm rigid endoscope with a 0° lens and a malleable irrigation suction cannula.
Endoscopic surgery was performed under local anesthesia. The mean age of the patients was 82.6 years (range 73-91 years). There were 5 female and 6 male patients. The mean preoperative Glasgow Coma Scale score was 12, and 5 patients had been receiving antithrombotic drug therapy. The mean operation time was 85 minutes. Only 1 patient had rebleeding, and reoperation with the same technique was performed uneventfully in this individual. A total of 7 patients had a good recovery (modified Rankin Scale Score 0-2) at discharge.
Endoscopic hematoma evacuation of acute and subacute SDH is a safe and effective method of clot removal that minimizes operative complications. This technique may be a less invasive method for treating elderly patients with acute and subacute SDHs.
对急性或亚急性硬膜下血肿（SDH）进行内镜手术，并评估其在老年患者中的有效性和安全性。
2007年9月至2013年11月期间，对11例急性SDH患者（8例）和亚急性SDH患者（3例）进行了内镜手术。手术标准如下：1）存在临床症状；2）年龄大于70岁；3）无脑损伤（脑内血肿、脑挫伤）；4）硬膜下血肿无增大；5）无出血高风险。使用带0°镜头的4毫米硬式内镜和可塑形冲洗吸引套管进行血肿清除。
内镜手术在局部麻醉下进行。患者的平均年龄为82.6岁（范围73 - 91岁）。有5名女性和6名男性患者。术前格拉斯哥昏迷量表平均评分为12分，5例患者一直在接受抗血栓药物治疗。平均手术时间为85分钟。仅1例患者发生再出血，该患者采用相同技术再次手术顺利。共有7例患者出院时恢复良好（改良Rankin量表评分0 - 2）。
急性和亚急性SDH的内镜血肿清除术是一种安全有效的清除血凝块方法，可将手术并发症降至最低。该技术可能是治疗老年急性和亚急性SDH患者的一种侵入性较小的方法。
