Kareem Haider, Adams Hadie
Department of Neurosurgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
Department of Neurosurgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
F1000Res. 2018 May 21;7:619. doi: 10.12688/f1000research.14932.1. eCollection 2018.
Chronic subdural haematoma (CSDH), is a common neurosurgical disorder that is associated with morbidity and mortality affecting the ageing population. The aim is to present the treatment experience of CSDH patients treated with a technique that combines the classical single burr-hole irrigation and the continuous closed system drainage: The closed system irrigation & drainage (CSID) technique. The cases undergoing CSDH evacuation with the CSID method were captured over a 4-year period at a tertiary neurosurgical centre. The authors describe the performance of this methods with respect to post-operative clinical and radiological features, including recurrence rates, complications, and length of stay. A total of 36 cases undergoing 42 CSID procedures (30 unilateral and 6 bilateral CSDHs) were performed, in cases ranging between 55-95 years old (median age 79 years). The rate of recurrence or significant ruminant blood in the subdural space on post-operative imaging was 11% (n=4). No cases of pneumocephalus were observed in this series (n=0). The mean (SD) skin-to-skin time for this procedure was 13.4 (4.4) minutes, with a mean (SD) length of stay of 4 (1.9) days. We conclude that the one burr-hole closed system irrigation and drainage technique with a sub-periosteal drain seems to be a simple, effective and safe procedure for treatment of CSDH. It's well tolerated under local anaesthesia for patients with high co-morbidities and these preliminary results indicated it may potentially be a better option for treatment of CSDH with a lower rate of post-operative complications.
慢性硬膜下血肿（CSDH）是一种常见的神经外科疾病，与影响老年人群的发病率和死亡率相关。目的是介绍采用经典单钻孔冲洗与持续封闭系统引流相结合技术（封闭系统冲洗引流（CSID）技术）治疗CSDH患者的治疗经验。在一家三级神经外科中心，对4年期间采用CSID方法进行CSDH清除术的病例进行了记录。作者描述了该方法在术后临床和影像学特征方面的表现，包括复发率、并发症和住院时间。共进行了36例42次CSID手术（30例单侧CSDH和6例双侧CSDH），患者年龄在55至95岁之间（中位年龄79岁）。术后影像学检查发现硬膜下间隙复发或有大量反刍样血液的发生率为11%（n = 4）。本系列未观察到气颅病例（n = 0）。该手术的平均（标准差）皮肤对皮肤时间为13.4（4.4）分钟，平均（标准差）住院时间为4（1.9）天。我们得出结论，采用骨膜下引流的单钻孔封闭系统冲洗引流技术似乎是治疗CSDH的一种简单、有效且安全的方法。对于合并症多的患者，在局部麻醉下耐受性良好，这些初步结果表明，它可能是治疗CSDH的更好选择，术后并发症发生率较低。
