Balevi Mustafa
Department of Neurosurgery, Konya Numune Hospital, Konya, Turkey.
Asian J Neurosurg. 2017 Oct-Dec;12(4):598-604. doi: 10.4103/ajns.AJNS_8_15.
The aim of this retrospective study is to evaluate the efficacy and incidence of complications of craniotomy and membranectomy in elderly patients for the treatment of organized chronic subdural hematoma (OCSH).
We retrospectively reviewed a series of 28 consecutive patients suffering from OCSH, diagnosed by magnetic resonance imaging (MRI) or computer tomography (CT) to establish the degree of organization and determine the intrahematomal architecture including inner membrane ossification. The indication to perform a primary enlarged craniotomy as initial treatment for nonliquefied OCSH with multilayer loculations was based on the hematoma MRI appearance - mostly hyperintense in both T1- and T2-weighted images with a hypointense web- or net-like structure within the hematoma cavity or inner membrane calcification CT appearance - hyperdense. These cases have been treated by a large craniotomy with extended membranectomy as the initial treatment. However, the technique of a burr hole with closed system drainage for 24-72 h was chosen for cases of nonseptated and mostly liquefied Chronic Subdural Hematoma (CSDH).
Between 1998 and 2015, 148 consecutive patients were surgically treated for CSDH at our institution. Of these, 28 patients which have OSDH underwent a large craniotomy with extended membranectomy as the initial treatment. The average age of the patients was 69 (69.4 ± 12.1). Tension pneumocephalus (TP) has occurred in 22.8% of these patients ( = 28). Recurring subdural hemorrhage (RSH) in the operation area has occurred in 11.9% of these patients in the first 24 h. TP with RSH was seen in 4 of 8 TP patients (50%). Large epidural air was seen in one case. Postoperative seizures requiring medical therapy occurred in 25% of our patients. The average stay in the department of neurosurgery was 11 days, ranging from 7 to 28 days. Four patients died within 28 days after surgery; mortality rate was 14.28%.
Large craniotomy and extended membrane excision for OSDH still carry a high rate of mortality and morbidity in elderly patients. TP, RSH, and postoperative seizures are frequently seen complications in elderly patients.
本回顾性研究旨在评估老年患者开颅手术和硬膜切除术治疗机化性慢性硬膜下血肿（OCSH）的疗效及并发症发生率。
我们回顾性分析了连续28例OCSH患者，通过磁共振成像（MRI）或计算机断层扫描（CT）确诊，以确定机化程度并明确血肿内结构，包括内膜骨化情况。对于多层分隔的非液化OCSH，以血肿MRI表现（T1加权和T2加权图像上大多为高信号，血肿腔内有低信号的条索状或网状结构或内膜钙化CT表现为高密度）为依据，行一期扩大开颅手术作为初始治疗。这些病例均采用扩大开颅并扩大硬膜切除术作为初始治疗。然而，对于非分隔且大多液化的慢性硬膜下血肿（CSDH）病例，则选择采用带封闭系统引流的钻孔术，持续24 - 72小时。
1998年至2015年期间，我院共有148例连续患者接受了CSDH手术治疗。其中，28例OSDH患者接受了扩大开颅并扩大硬膜切除术作为初始治疗。患者的平均年龄为69岁（69.4±12.1）。这些患者中22.8%（n = 28）发生了张力性气颅（TP）。11.9%的患者在术后24小时内手术区域出现复发性硬膜下出血（RSH）。8例TP患者中有4例（50%）出现TP合并RSH。1例出现大量硬膜外积气。25%的患者术后发生需要药物治疗的癫痫发作。神经外科平均住院时间为11天，范围为7至28天。4例患者术后28天内死亡；死亡率为14.28%。
老年患者行OSDH扩大开颅和扩大硬膜切除术仍具有较高的死亡率和发病率。TP、RSH和术后癫痫发作是老年患者常见的并发症。
