Yadav Yad Ram, Ratre Shailendra, Parihar Vijay, Bajaj Jitin, Sinha Mallika, Kumar Ambuj
Department of Neurosurgery, Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, India.
J Neurol Surg A Cent Eur Neurosurg. 2020 Jul;81(4):330-341. doi: 10.1055/s-0039-1698388. Epub 2020 Mar 16.
Twist drill evacuation, burr hole aspiration, mini-craniotomy, and craniotomy are some of the surgical methods to remove chronic subdural hematoma (CSDH). Endoscopic treatment was also recently found to be useful.
We conducted a prospective study of 72 hematomas in 68 patients. Computed tomography was performed in all cases. Endoscopic surgery was performed in all CSDH patients.
A 4-cm skin incision was performed at the most curved part of skull with the CSDH. A mini-craniotomy or enlarged burr hole was made. The inner and outer table of the burr hole margin was drilled to provide a straight trajectory to the hematoma cavity. An endoscope supported by a telescope holder was used. A modified silicone brain retractor was used in five patients. A subgaleal drain was left in all patients for 3 to 5 days.
There were 42 male and 26 female patients. The age ranged from 45 to 79 years (average: 69 years). All patients had a history of head trauma. Preoperative average Glasgow Coma Scale Score was 14. The procedure was effective in hematoma evacuation and a good visualization of the whole cavity in all patients. The endoscopic technique helped in complete hematoma removal in organized/solid clot, septations, and bridging vessels in 17, 2, and 2 cases, respectively. Duration of surgery ranged from 35 to 80 minutes. One death occurred. There was no recurrence, infection, fresh bleed, or injury to the brain or membrane.
The endoscopic technique is an effective alternative technique for treating CSDH. Although the study has limitations because of the small number of patients with a short follow-up, the study indicated that thick and vascular membranes, septations, and organized and solid clots can be removed effectively using this technique.
麻花钻引流、钻孔抽吸、微创开颅术和开颅术是清除慢性硬膜下血肿（CSDH）的一些手术方法。最近还发现内镜治疗也很有用。
我们对68例患者的72个血肿进行了前瞻性研究。所有病例均进行了计算机断层扫描。所有CSDH患者均接受了内镜手术。
在患有CSDH的颅骨最弯曲部位做一个4厘米的皮肤切口。进行微创开颅术或扩大钻孔。在钻孔边缘的内板和外板进行钻孔，以提供一条通向血肿腔的直线轨迹。使用由望远镜支架支撑的内窥镜。5例患者使用了改良的硅胶脑牵开器。所有患者均留置帽状腱膜下引流管3至5天。
男性患者42例，女性患者26例。年龄范围为45至79岁（平均：69岁）。所有患者均有头部外伤史。术前格拉斯哥昏迷量表平均评分为14分。该手术在血肿清除方面有效，且所有患者的整个血肿腔均能良好显影。内镜技术分别帮助17例、2例和2例患者完全清除了机化/实性血凝块、分隔和桥接血管中的血肿。手术时间为35至80分钟。1例患者死亡。无复发、感染、新鲜出血或脑或脑膜损伤。
内镜技术是治疗CSDH的一种有效替代技术。尽管由于患者数量少且随访时间短，该研究存在局限性，但该研究表明，使用该技术可以有效清除增厚的血管膜、分隔以及机化和实性血凝块。
