Yadav Yad Ram, Parihar Vijay, Chourasia Ishwar D, Bajaj Jitin, Namdev Hemant
Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India.
Department of Neurosurgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India.
Asian J Neurosurg. 2016 Jul-Sep;11(3):214-8. doi: 10.4103/1793-5482.145096.
There is lack of uniformity about the preferred surgical treatment, role of drain, and type of drain among various surgeons in chronic subdural hematoma (CSDH). The present study is aimed to evaluate role of subgaleal drain.
This was a prospective study of 260 patients of CSDH treated surgically. Burr-hole irrigation with and without suction drain was done in 140 and 120 patients, respectively. Out of 120 patients without suction drain 60 each were managed by single and two burr holes. Pre- and postoperative GCS was recorded. Recurrent hematomas, CSDH secondary to tumor, due to intracranial hypotension, coagulopathy, children below 18 years, and patients treated by twist drill craniostomy or craniotomy were excluded. Subgaleal closed-system drainage with low negative pressure was used.
Age of the patients ranged from 18 to 75 years with mean age of 57 years. There were 9, 47, 204 patients in GCS of 3-8, 9-12, and 13-15, respectively. Both the groups were comparable in terms of age, etiology, gender, and neurological status. There was no difference in the mortality in both the group. The recurrence and postoperative pneumocephalus was significantly less in suction drain group as compared to without drain group. There was no infection or any other complication related to suction drainage.
Subgaleal closed suction drainage was safe, simple, and effective in the management of CSDH. Recurrence rate was low in the suction drain group.
在慢性硬膜下血肿（CSDH）的治疗中，不同外科医生对于首选手术方式、引流管的作用及类型缺乏统一认识。本研究旨在评估帽状腱膜下引流管的作用。
这是一项对260例接受手术治疗的CSDH患者的前瞻性研究。分别对140例和120例患者进行了带或不带吸引引流管的钻孔冲洗。在120例未使用吸引引流管的患者中，60例通过单钻孔和双钻孔进行处理。记录术前和术后的格拉斯哥昏迷量表（GCS）评分。排除复发性血肿、肿瘤继发的CSDH、颅内低压、凝血功能障碍、18岁以下儿童以及采用手摇钻颅骨钻孔术或开颅手术治疗的患者。采用低负压的帽状腱膜下封闭式引流。
患者年龄范围为18至75岁，平均年龄57岁。GCS评分为3 - 8分、9 - 12分和13 - 15分的患者分别有9例、47例和204例。两组在年龄、病因、性别和神经状态方面具有可比性。两组的死亡率无差异。与无引流管组相比，吸引引流管组的复发率和术后气颅明显更低。未发生与吸引引流相关的感染或任何其他并发症。
帽状腱膜下封闭式吸引引流在CSDH的治疗中安全、简单且有效。吸引引流管组的复发率较低。
