Kale Aydemir, Öz İbrahim İlker, Gün Eren Görkem, Kalaycı Murat, Gül Şanser
a Faculty of Medicine, Department of Neurosurgery , Bülent Ecevit University , Zonguldak , Turkey.
b Faculty of Medicine, Department of Radiology , Bülent Ecevit University , Zonguldak , Turkey.
Neurol Res. 2017 May;39(5):399-402. doi: 10.1080/01616412.2017.1296655. Epub 2017 Feb 22.
Chronic subdural hematoma (CSDH) is the most frequent type of intracranial hemorrhage which especially affects the elderly. Various surgical techniques have been reported for CSDH treatment; optimal treatment methods are still controversial. In this study, the effects of long drainage durations on results and recurrences were investigated in patients on whom closed system drainage with burr hole craniotomy was applied due to CSDH.
90 patients with 105 CSDH were operated between 2008 and 2016. Patients were divided into two groups based on the duration of drainage. Group A (n = 40) was determined as 2-4 days of closed-system drainage, while Group B (n = 50) was recorded as 5-7 days of closed-system drainage. Recurrence was defined as accumulation of blood in the operation area and recurrence of symptoms within the monitoring period of six months.
Recurrence was observed in 7 (15.6) of the Group A patients and 2 (3.3%) of the Group B patients. There was a statistically significant difference between groups in terms of recurrence rate (p = 0.04). Postoperative thickness of hematoma was measured in the first month follow-up computerized tomography. There was a statistically significant difference between groups in terms of postoperative thickness of residual hematoma (p = 0.05).
2-4 days of closed system drainage following burr hole craniotomy is an effective and reliable choice of treatment in CSDH. Nevertheless, increasing the duration of drainage to 5-7 days provided better results without increasing the risk of complication.
慢性硬膜下血肿（CSDH）是最常见的颅内出血类型，尤其好发于老年人。已有多种手术技术用于治疗CSDH；最佳治疗方法仍存在争议。在本研究中，对因CSDH行钻孔开颅闭式引流术的患者，研究长时间引流对治疗效果和复发情况的影响。
2008年至2016年间，对90例患者的105处CSDH进行了手术。根据引流时间将患者分为两组。A组（n = 40）为闭式引流2 - 4天，而B组（n = 50）记录为闭式引流5 - 7天。复发定义为手术区域内血液积聚以及在六个月的监测期内症状复发。
A组患者中有7例（15.6%）出现复发，B组患者中有2例（3.3%）出现复发。两组在复发率方面存在统计学显著差异（p = 0.04）。在首次随访的计算机断层扫描中测量了术后血肿厚度。两组在残余血肿的术后厚度方面存在统计学显著差异（p = 0.05）。
钻孔开颅术后2 - 4天的闭式引流是CSDH一种有效且可靠的治疗选择。然而，将引流时间延长至5 - 7天可取得更好的效果，且不增加并发症风险。
