Hamed Motaz, Schuss Patrick, Daher Frederick H, Borger Valeri, Güresir Ági, Vatter Hartmut, Güresir Erdem
Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.
Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.
World Neurosurg. 2016 Oct;94:501-506. doi: 10.1016/j.wneu.2016.07.061. Epub 2016 Jul 25.
Traumatic acute subdural hematoma (aSDH) is a severe disease. Surgical treatment is still controversially discussed, especially in patients with additional signs of cerebral herniation. However, previously investigated patient populations were heterogeneous. We therefore performed an analysis of our institutional data in a large homogenous selection of patients with traumatic aSDH to analyze factors determining clinical outcome.
Between 2010 and 2014, 196 patients with aSDH underwent surgical treatment in our department. Information including patient characteristics, treatment modality, radiologic features, and functional outcome were analyzed. Outcome was assessed according to the Glasgow Outcome Scale (GOS) at 6 months and was dichotomized into favorable (GOS score, 1-3) and unfavorable (GOS score 4-5) outcome. Furthermore, a multivariate analysis was performed to identify independent predictors of functional outcome.
Overall, 26% of patients with aSDH achieved favorable outcome. In further analysis, unilateral or bilateral dilated pupils as a sign of cerebral herniation were present in 47% of the included patients. In the multivariate analysis, age >70 years and the presence of cerebral herniation were significant prognostic predictors for unfavorable outcome in patients with aSDH. However, 15% of patients with aSDH and signs of cerebral herniation achieved favorable outcome during follow-up.
We provide detailed data on patients with aSDH and signs of cerebral herniation. Despite mydriasis, favorable outcome may be achieved in many patients. Nevertheless, careful individual decision making is necessary for each patient, especially when signs of cerebral herniation have persisted for a long time.
创伤性急性硬膜下血肿（aSDH）是一种严重疾病。对于其外科治疗仍存在争议，尤其是在伴有脑疝其他体征的患者中。然而，此前所研究的患者群体具有异质性。因此，我们对本院大量同质的创伤性aSDH患者数据进行了分析，以剖析决定临床结局的因素。
2010年至2014年间，196例aSDH患者在我科接受了外科治疗。对包括患者特征、治疗方式、影像学特征及功能结局等信息进行了分析。在6个月时根据格拉斯哥预后量表（GOS）评估结局，并将其分为良好（GOS评分，1 - 3）和不良（GOS评分4 - 5）结局。此外，进行了多因素分析以确定功能结局的独立预测因素。
总体而言，26%的aSDH患者获得了良好结局。在进一步分析中，47%的纳入患者存在单侧或双侧瞳孔散大作为脑疝的体征。在多因素分析中，年龄>70岁和存在脑疝是aSDH患者不良结局的显著预后预测因素。然而，15%有脑疝体征的aSDH患者在随访期间获得了良好结局。
我们提供了有关aSDH及脑疝体征患者的详细数据。尽管存在瞳孔散大，但许多患者仍可能获得良好结局。尽管如此，对每位患者都需要进行谨慎的个体化决策，尤其是当脑疝体征持续较长时间时。
