Szmuda Tomasz, Kierońska Sara, Słoniewski Paweł, Dzierżanowski Jarosław
Department of Neurosurgery, Medical University of Gdansk, Gdansk, Poland.
Wideochir Inne Tech Maloinwazyjne. 2019 Sep;14(3):442-450. doi: 10.5114/wiitm.2019.83001. Epub 2019 Feb 18.
Standard craniotomy (SC) and burr hole craniostomy (BHC) are regarded as the standard approaches to chronic subdural haematoma (CSDH). Bedside twist drill craniostomy (TDC), performed at the patient's bedside, was introduced as an alternative to the standard methods. However, clinical and radiological features of patients treated with TDC and BHC/SC have not been compared.
To demonstrate the specific features of CSDH that affect the surgeons' preferences when selecting patients for TDC.
A retrospective analysis of 32 patients treated due to CSDH in the year 2017 at a single institution was performed. Baseline radiological characteristics, clinical status at admission, complication rate and clinical outcomes were compared between BHC/SC and TDC.
Of the 32 patients, 5 (15.6%) were treated using TDC and 27 (84.4%) by SC or BHC. The duration of the TDC procedure was significantly shorter than the time of standard therapies (p < 0.01). There were no differences between TDC and BHC/SC in terms of baseline clinical characteristics, including age, gender, head trauma history, diabetes, hypertension, antiplatelet drug use, clinical manifestation and the Glasgow Coma Scale score (all p > 0.05). Patients treated with TDC had a significantly thicker haematoma (TDC vs. BHC/SC: mean 25.3 mm vs. 14.6 mm) (p < 0.01) and demonstrated a smaller midline shift (TDC vs. BHC/SC: mean 0.5 mm vs. 4.0 mm) (p = 0.01) compared to those treated with BHC/SC.
Twist drill craniostomy is a more effective method for CSDH evacuation compared to SC and BHC. This procedure is considered as the first line treatment for patients with a thicker and non-septated haematoma, and with a smaller midline shift.
标准开颅术（SC）和钻孔引流术（BHC）被视为慢性硬膜下血肿（CSDH）的标准治疗方法。床边锥颅术（TDC）是在患者床边进行的一种替代标准方法的术式。然而，接受TDC治疗的患者与接受BHC/SC治疗的患者的临床和影像学特征尚未进行比较。
阐述影响外科医生选择TDC治疗CSDH患者的特定特征。
对2017年在某单一机构因CSDH接受治疗的32例患者进行回顾性分析。比较BHC/SC组和TDC组的基线影像学特征、入院时的临床状况、并发症发生率及临床结局。
32例患者中，5例（15.6%）接受TDC治疗，27例（84.4%）接受SC或BHC治疗。TDC手术持续时间明显短于标准治疗时间（p<0.01）。TDC组与BHC/SC组在基线临床特征方面无差异，包括年龄、性别、头部外伤史、糖尿病、高血压、抗血小板药物使用情况及临床表现和格拉斯哥昏迷量表评分（均p>0.05）。与接受BHC/SC治疗的患者相比，接受TDC治疗的患者血肿明显更厚（TDC组与BHC/SC组：平均25.3mm对14.6mm）（p<0.01），中线移位更小（TDC组与BHC/SC组：平均0.5mm对4.0mm）（p=0.01）。
与SC和BHC相比，锥颅术是一种更有效的CSDH清除方法。该术式被认为是治疗血肿较厚且无分隔、中线移位较小患者的一线治疗方法。
