Singh Jagminder, Sobti Shivender, Chaudhary Ashwani, Chaudhary Vikram, Garg Tarun
Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Asian J Neurosurg. 2021 Feb 23;16(1):96-98. doi: 10.4103/ajns.AJNS_101_20. eCollection 2021 Jan-Mar.
Chronic subdural hematoma (CSDH) is seen most common in geriatric patients, and trauma is the most important reason for CSDH. Operative treatment of CSDH in symptomatic patients is yet the gold standard of therapy because it allows decompression of the subdural space and aids improvement in neurological status. Burr-hole craniostomy is the most common accepted treatment for CSDH. There is still controversy regarding which type of drain placement is best in the outcome: subdural or subgaleal drain.
The aim of the study was to compare the outcome of subgaleal versus subdural drain in surgically treated patients of CSDH.
Patients were assigned by simple random sampling in two groups. The study was conducted from February 2016 to July 2017. A total of 70 patients were enrolled into the study and were divided in two groups (Group 1 - Subgaleal drain; Group 2 - Subdural drain). Statistical analysis was done using Chi-square and -test. Outcome was assessed at the end of hospital stay by modified Rankin scale. Postoperative computed tomography scan was done after 24 h of surgery.
This study concluded that both types of drains are equally effective for the treatment of CSDH. There is a statistically significant difference in the occurrence of seizure in both the groups as there was no seizure in subgaleal drain group compared to 5 (14.3%) patients who had seizures postoperatively in subdural drain group ( = 0.020). There was insignificant difference with respect to preoperative Glasgow Coma Scale/sex/preoperative hematoma volume/postoperative hematoma volume/preoperative midline shift.
Subgaleal drain is safe and technically easy, as subgaleal drain has no direct contact with brain parenchyma, thus less chances of brain laceration, intracerebral hematoma formation, and seizures.
慢性硬膜下血肿（CSDH）在老年患者中最为常见，创伤是CSDH最重要的原因。有症状的CSDH患者的手术治疗仍是治疗的金标准，因为它可以使硬膜下腔减压并有助于改善神经功能状态。钻孔开颅术是CSDH最常用的公认治疗方法。关于哪种类型的引流管放置对治疗效果最佳仍存在争议：硬膜下引流还是帽状腱膜下引流。
本研究的目的是比较CSDH手术治疗患者中帽状腱膜下引流与硬膜下引流的治疗效果。
通过简单随机抽样将患者分为两组。研究于2016年2月至2017年7月进行。共有70例患者纳入研究并分为两组（第1组 - 帽状腱膜下引流；第2组 - 硬膜下引流）。使用卡方检验和t检验进行统计分析。在住院结束时通过改良Rankin量表评估治疗效果。术后24小时进行术后计算机断层扫描。
本研究得出结论，两种类型的引流管对CSDH的治疗同样有效。两组癫痫发作的发生率存在统计学显著差异，因为帽状腱膜下引流组未发生癫痫发作，而硬膜下引流组有5例（14.3%）患者术后发生癫痫发作（P = 0.020）。在术前格拉斯哥昏迷量表/性别/术前血肿体积/术后血肿体积/术前中线移位方面差异不显著。
帽状腱膜下引流安全且技术操作简单，因为帽状腱膜下引流与脑实质无直接接触，因此脑裂伤、脑内血肿形成和癫痫发作的几率较小。
