Májovský Martin, Netuka David, Beneš Vladimír, Kučera Pavel
Department of Neurosurgery and Neurooncology, First Faculty of Medicine of Charles University, Military University Hospital, Prague, Czech Republic.
Department of Natural Sciences, Faculty of Biomedical Engineering, Czech Technical University, Prague, Czech Republic.
J Neurosci Rural Pract. 2019 Jan-Mar;10(1):113-118. doi: 10.4103/jnrp.jnrp_167_18.
Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Despite ongoing efforts, recurrence and reoperation rates after surgical treatment remain high. We synthesize scientific evidence on the treatment of CSDH with biophysical principles and then propose a simple and effective surgical technique aiming to reduce the recurrence rate. Under local anesthesia, one burr hole is placed in the area above the maximum hematoma thickness. One drain is inserted into the dorsal direction to the deepest point of the hematoma cavity, and a second drain is inserted frontally into the highest point. Next, saline is gently instilled to the dorsal drain to eliminate air from the hematoma cavity through the frontal drain. Once saline has filled the frontal drain, the frontal drain is removed. The dorsal drain is left for 48 h, and the pressure within the cavity may be adapted hydrostatically. We implemented evidence-based conclusions of previous studies and modified the classical burr-hole technique to reduce the recurrence rate. As a result, we developed a straightforward surgical procedure that is possible to perform under local anesthesia, suitable for everyday practice in rural and remote areas while working with limited resources. The novelty of this technique is in the purposeful reduction of postoperative pneumocephalus, a known independent factor of recurrence. Subdural air is eliminated during surgery using a two-drain system. Safety and efficacy of the technique need to be evaluated in future clinical trials.
慢性硬膜下血肿（CSDH）是最常见的神经外科病症之一。尽管不断努力，但手术治疗后的复发率和再次手术率仍然很高。我们结合生物物理原理综合了关于CSDH治疗的科学证据，然后提出了一种简单有效的手术技术，旨在降低复发率。在局部麻醉下，在血肿最大厚度上方区域钻一个骨孔。将一根引流管向背侧插入血肿腔的最深点，另一根引流管向前插入最高点。接下来，将生理盐水轻轻注入背侧引流管，通过额部引流管排出血肿腔内的空气。一旦生理盐水充满额部引流管，就将其拔除。背侧引流管留置48小时，腔内压力可通过流体静力原理进行调节。我们采用了先前研究基于证据的结论，并对经典骨孔技术进行了改良，以降低复发率。结果，我们开发了一种简单的手术方法，该方法可以在局部麻醉下进行，适用于资源有限的农村和偏远地区的日常实践。该技术的新颖之处在于有目的地减少术后气颅，气颅是已知的复发独立因素。在手术过程中使用双引流系统消除硬膜下积气。该技术的安全性和有效性需要在未来的临床试验中进行评估。
