Department of Neurosurgery, Bethel Clinic, Bielefeld, Germany.
Department of Neurosurgery, Bethel Clinic, Bielefeld, Germany.
World Neurosurg. 2019 Aug;128:e1010-e1023. doi: 10.1016/j.wneu.2019.05.063. Epub 2019 May 16.
Chronic subdural hematoma (CSDH) is a common neurosurgical condition, especially among elderly patients. Here we have analyzed our institutional experience with surgical management of CSDH. We aimed at identifying predictors of hematoma recurrence and cure, and the respective time course.
Pertinent data were collected from all 208 patients (136 males; median age, 78 years) treated for unilateral CSDH in our department from 2014 to 2016 after exclusion of cases with CSDH following previous head surgery or missing postoperative imaging. Pre- and postoperative neuroimaging studies were subjected to computer-assisted volumetric analyses. CSDH composition and anatomy were assessed using a modified Nakaguchi classification.
A total of 67.8% of the patients presented with neurologic deficits, and 51.4% were at least on 1 anticoagulant agent. Burr hole trephinations were performed in 94.7%. The median residual hematoma volume was 35.0 mL (44.1 mL including air). Surgical recurrences were seen in 17.8%. The median time to repeat surgery was 17 days, and 91.9% of recurrences occurred within 60 days. Recurrence rates varied between 36.4% (separated or trabecular subtypes and postoperative CSDH volume ≥35.0 mL) and 3.7% (all other subtypes and postoperative CSDH volume <35.0 mL). A neuroimaging proven cure could be documented in an estimated 90% of cases at 145 days after first surgery.
Postoperative CSDH volume and the Nakaguchi classification subtypes proved the most powerful predictors of recurrence, cure, and the time to recurrence and cure. Although our results demonstrate the important impact of CSDH volume, composition, and anatomy, they also show that other so far unknown factors play a significant role as well.
慢性硬脑膜下血肿（CSDH）是一种常见的神经外科疾病，尤其多见于老年患者。在此，我们分析了我们机构在 CSDH 手术治疗方面的经验。我们旨在确定血肿复发和治愈的预测因素，以及各自的时间进程。
从 2014 年至 2016 年，我们排除了既往头部手术后出现 CSDH 或术后影像学资料缺失的病例，对在我科接受单侧 CSDH 治疗的 208 例（男性 136 例；中位年龄 78 岁）患者的相关数据进行了收集。对术前和术后的神经影像学研究进行了计算机辅助容积分析。使用改良的 Nakaguchi 分类法评估 CSDH 成分和解剖结构。
共有 67.8%的患者存在神经功能缺损，51.4%的患者至少使用了 1 种抗凝药物。94.7%的患者行颅骨钻孔引流术。中位残余血肿量为 35.0 毫升（包括空气则为 44.1 毫升）。手术复发率为 17.8%。再次手术的中位时间为 17 天，91.9%的复发发生在 60 天内。复发率在 36.4%（分隔型或小梁型和术后 CSDH 量≥35.0 毫升）和 3.7%（所有其他亚型和术后 CSDH 量<35.0 毫升）之间变化。首次手术后 145 天，通过神经影像学可证实约 90%的病例达到治愈。
术后 CSDH 量和 Nakaguchi 分类亚型是复发、治愈以及复发和治愈时间的最有力预测因素。尽管我们的结果表明 CSDH 量、成分和解剖结构的重要影响，但它们也表明其他目前未知的因素也起着重要作用。
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