年轻患者急性硬膜下血肿的内镜下血肿清除术：一例报告
Endoscopic hematoma evacuation for acute subdural hematoma in a young patient: a case report.
作者信息
Kuge Atsushi, Tsuchiya Daisuke, Watanabe Shigeki, Sato Mitsuya, Kinjo Toshihiko
机构信息
Department of Emergency Medicine Okitama Public General Hospital Yamagata Japan.
Department of Neurosurgery Okitama Public General Hospital Yamagata Japan.
出版信息
Acute Med Surg. 2017 Jul 17;4(4):451-453. doi: 10.1002/ams2.295. eCollection 2017 Oct.
CASE
The standard treatment for acute subdural hematoma (ASDH) is large craniotomy; decompressive craniectomy may also be carried out, if needed, to prevent secondary brain damage. Recently, an endoscopic procedure for elderly patients with ASDH was carried out and reported; its safety and effectiveness were emphasized because of minimal invasiveness. We report a young case and discuss its difficulties and tips.A 31-year-old man was found to be in a state of general convulsion. At the time of admission, we observed severe consciousness disturbance, anisocoria, and left hemiparesis. Computed tomography showed a massive subdural hematoma with marked midline shift.
OUTCOME
Osmotherapy and emergency trepanation improved anisocoria. An endoscopic procedure under local anesthesia was sequentially selected. After surgery, the patient's symptoms clearly improved.
CONCLUSION
Although the standard treatment for ASDH is craniotomy, endoscopic surgery may be useful in some cases.
病例
急性硬膜下血肿（ASDH）的标准治疗方法是大骨瓣开颅术；如有必要，也可进行减压性颅骨切除术，以防止继发性脑损伤。最近，针对老年ASDH患者开展了一种内镜手术并进行了报道；因其微创性，其安全性和有效性得到了强调。我们报告了一例年轻患者的病例，并讨论了其中的难点和技巧。一名31岁男性被发现处于全身抽搐状态。入院时，我们观察到其存在严重意识障碍、瞳孔不等大及左侧偏瘫。计算机断层扫描显示有巨大硬膜下血肿，中线明显移位。
结果
渗透性疗法和紧急开颅术改善了瞳孔不等大的情况。随后选择了局部麻醉下的内镜手术。术后，患者症状明显改善。
结论
虽然ASDH的标准治疗方法是开颅术，但内镜手术在某些情况下可能有用。
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