Hoffman Haydn, Ziechmann Robert, Beutler Timothy, Verhave Brendon, Chin Lawrence S
Department of Neurosurgery, State University of New York Upstate, 750 E. Adams St., Syracuse, NY 13202, United States.
Department of Neurosurgery, State University of New York Upstate, 750 E. Adams St., Syracuse, NY 13202, United States.
J Clin Neurosci. 2018 Apr;50:221-225. doi: 10.1016/j.jocn.2018.01.068. Epub 2018 Feb 7.
Chronic subdural hematoma (cSDH) is a common condition that disproportionately affects older patients. Given the greater risks of general anesthesia in this population, interest has turned towards less invasive surgical approaches such as the subdural evacuating port system (SEPS; Medtronic, Inc., Minneapolis, MN). There is a relative dearth of information about the outcomes following this procedure. Here, we present our institution's experience with SEPS and analyze factors associated with the outcomes. Using a prospectively maintained institutional database, we retrospectively identified all patients who presented with cSDH and received first line therapy with SEPS. Pre- and post-operative clinical and radiographic data was obtained from the electronic health record. Outcomes included success or failure, Modified Rankin Scale (mRS) at discharge, length of stay (LOS), and discharge disposition. A total of 126 patients met the inclusion criteria (36 females and 90 males; mean age of 71.6 years). None of the pre-procedural clinical or radiographic variables were associated with the likelihood of a successful outcome. Increasing age was associated with non-routine hospital discharge (p = 0.003), and lower presenting GCS was associated with longer hospital stay (p = 0.005). Greater thickness of the cSDH was associated with a lower likelihood of having a favorable outcome (mRS ≥ 3; p = 0.003). SEPS is an effective first-line therapy for cSDH. Variables previously reported to limit the effectiveness of the technique (presence of septations, mixed density collections) were not associated with treatment failure.
慢性硬膜下血肿（cSDH）是一种常见疾病，对老年患者的影响尤为严重。鉴于该人群全身麻醉风险更高，人们的兴趣已转向侵入性较小的手术方法，如硬膜下引流端口系统（SEPS；美敦力公司，明尼阿波利斯，明尼苏达州）。关于该手术后的结果，相关信息相对较少。在此，我们介绍我们机构使用SEPS的经验，并分析与结果相关的因素。利用前瞻性维护的机构数据库，我们回顾性确定了所有出现cSDH并接受SEPS一线治疗的患者。术前和术后的临床及影像学数据均从电子健康记录中获取。结果包括手术成功或失败、出院时的改良Rankin量表（mRS）评分、住院时间（LOS）和出院处置情况。共有126例患者符合纳入标准（36例女性和90例男性；平均年龄71.6岁）。术前的临床或影像学变量均与手术成功的可能性无关。年龄增加与非常规出院相关（p = 0.003），入院时较低的格拉斯哥昏迷量表（GCS）评分与较长的住院时间相关（p = 0.005）。cSDH厚度增加与良好预后（mRS≥3）的可能性较低相关（p = 0.003）。SEPS是治疗cSDH的一种有效一线疗法。先前报道的限制该技术有效性的变量（存在分隔、混合密度血肿）与治疗失败无关。
