Department of Neurosurgery, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China.
Department of Oncological Surgery, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China.
J Neurol Surg A Cent Eur Neurosurg. 2021 May;82(3):241-247. doi: 10.1055/s-0040-1721007. Epub 2021 Feb 4.
Organized chronic subdural hematoma (CSDH) is a special type of CSDH. However, the optimal surgical procedure has not been established. We present our experience here to discuss the surgical procedure in treatment of organized CSDH.
Thirty-three patients with organized CSDH were admitted between January 1, 2008 and January 1, 2018. Age, gender, clinical symptoms, imaging data, type of surgical procedure, Barthel index (BI), and postoperative complications were collected and retrospectively analyzed. The BI was assessed both pre and postoperatively (1 week and 1 month after surgery).
Overall, 14 patients underwent large craniotomy and 19 patients underwent small craniotomy. No significant differences in gender, age, initial clinical symptoms, and preoperative BI were found between the groups ( > 0.05). Among the 14 patients who underwent large craniotomy, 2 patients developed epilepsy after the operation, while 1 patient had postoperative aphasia. None of the patients had recurrence in 6 months postoperatively. Among the 19 patients who underwent small craniotomy, 1 patient developed an acute subdural hematoma and 1 patient developed aphasia. No obvious complications were found in the remaining 18 patients and none of the 19 patients had recurrence in 6 months postoperatively. BI scores of the small craniotomy group were significantly better than those of the large craniotomy group at 1 week postoperatively ( < 0.05). However, there was no significant difference in the 1-month results ( > 0.05).
According to our single-center experience, a small craniotomy for treating organized CSDH can be considered as an alternative to a larger craniotomy.
有组织的慢性硬脑膜下血肿（CSDH）是一种特殊类型的 CSDH。然而，尚未确定最佳的手术方法。我们在此介绍我们的经验，讨论治疗有组织的 CSDH 的手术方法。
2008 年 1 月 1 日至 2018 年 1 月 1 日期间收治了 33 例有组织的 CSDH 患者。收集并回顾性分析了年龄、性别、临床症状、影像学资料、手术类型、巴氏指数（BI）和术后并发症。BI 在术前（术后 1 周和 1 个月）和术后进行评估。
共有 14 例行大骨瓣开颅术，19 例行小骨瓣开颅术。大骨瓣开颅组和小骨瓣开颅组在性别、年龄、初始临床症状和术前 BI 方面无显著差异（>0.05）。在 14 例行大骨瓣开颅术的患者中，术后 2 例发生癫痫，1 例发生术后失语。术后 6 个月无复发。在 19 例行小骨瓣开颅术的患者中，1 例发生急性硬膜下血肿，1 例发生失语。其余 18 例患者无明显并发症，术后 6 个月无 19 例患者复发。术后 1 周，小骨瓣开颅组 BI 评分明显优于大骨瓣开颅组（<0.05）。但 1 个月时结果无显著差异（>0.05）。
根据我们的单中心经验，小骨瓣开颅术治疗有组织的 CSDH 可作为大骨瓣开颅术的替代方法。
