Department of Neurosurgery, The First People's Hospital of Ziyang, No. 66, Rende West Road, Ziyang, Sichuan, 641300, People's Republic of China.
Department of Otolaryngology, Head and Neck Surgery, The First People's Hospital of Ziyang, No. 66, Rende West Road, Ziyang, 641300, Sichuan, People's Republic of China.
BMC Surg. 2022 Jun 20;22(1):236. doi: 10.1186/s12893-022-01687-9.
Chronic subdural hematoma (CSDH) is the anomalous and encapsulated accumulation of fluid of complex origin consisting of old blood, mostly or totally liquified and cerebrospinal fluid (CSF) in the subdural space usually after a head injury in the elderly. Almost all the research on surgical techniques and endoscopic assisted evacuation of CSDH focused on the just the evacuation and not abnormal anatomical structures that causes recurrences.
We investigated abnormal anatomical structures that triggers recurrence of CSDH during craniotomy as well as burr-hole craniostomy with endoscopic assistance.
We retrospectively analyzed all patients with CSDH who underwent craniostomy and burr-hole craniotomy with endoscopic assisted evacuation of hematoma between April 2017 and November 2020 at our institution. Clinical data obtained was categorized into patient-related, radiology as well as surgery and endoscopic evaluations.
A total of 143 patients (109 men and 34 women) aged 43-94 years (mean age, 68.35 years) with CSDH were included in this study. We observed a recurrence rate of 4.9% (7/143). Recurrences occurred between 2 and 6 months after the operation in patients with recurrences. Our data revealed that, age, hypertension, history of injury, diabetes, antiplatelet or anticoagulant use were not associated with hematoma recurrence. Nevertheless, all the patients with recurrence of hematoma were males. Interestingly, our univariate and multivariate analyses found neomembrane thickness and hematoma cavity separation as independent risk factors (OR,45.822; 95% CI,2.666-787.711; p = 0.008) for the recurrence of CSDH (p < 0.05). Also, we observed thickened membranes connecting/separating the dura and the thickened arachnoid/pia matters in all the 7 patients with hematoma recurrence.
The treatment of patients with CSDH ought to include the identification and resection of abnormal thickened membranes connecting/separating the dura and the thickened arachnoid/pia matters to avoid recurrence. Comparatively, endoscopy showed hematoma cavity separation or neomembrane thickness just as seen during craniotomy.
慢性硬脑膜下血肿（CSDH）是一种异常的、被膜包裹的液体蓄积，其来源复杂，主要由陈旧血液组成，在老年人头部外伤后，几乎全部液化，部分或完全液化，在硬脑膜下腔积聚。几乎所有关于 CSDH 手术技术和内镜辅助清除的研究都集中在清除上，而不是引起复发的异常解剖结构上。
我们研究了开颅术和内镜辅助下颅骨钻孔术时引发 CSDH 复发的异常解剖结构。
我们回顾性分析了 2017 年 4 月至 2020 年 11 月期间在我院行颅骨钻孔术和内镜辅助血肿清除术的所有 CSDH 患者的临床资料。获得的临床资料分为患者相关、影像学、手术和内镜评估。
共纳入 143 例 CSDH 患者（男 109 例，女 34 例），年龄 43-94 岁（平均年龄 68.35 岁）。我们观察到复发率为 4.9%（7/143）。复发发生在术后 2-6 个月。我们的数据显示，年龄、高血压、外伤史、糖尿病、抗血小板或抗凝药物的使用与血肿复发无关。然而，所有血肿复发的患者均为男性。有趣的是，我们的单变量和多变量分析发现，新膜厚度和血肿腔分离是 CSDH 复发的独立危险因素（OR，45.822；95%CI，2.666-787.711；p=0.008）（p<0.05）。此外，我们在所有 7 例血肿复发患者中均观察到连接/分隔硬脑膜和增厚的蛛网膜/软脑膜的厚膜。
治疗 CSDH 患者时，应识别和切除连接/分隔硬脑膜和增厚的蛛网膜/软脑膜的异常增厚的膜，以避免复发。相比之下，内镜检查仅在开颅术中发现血肿腔分离或新膜增厚。
