Liu Tianqing, Gao Zhenwen, Zhou Jianjun, Lai Xiaoyan, Chen Xiaomei, Rao Qiong, Guo Dongbin, Zheng Jinliang, Lin Fuxin, Lin Yuanxiang, Lin Zhiqin
Department of Neurosurgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China.
Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
Front Neurol. 2023 Feb 15;14:1068829. doi: 10.3389/fneur.2023.1068829. eCollection 2023.
The subdural evacuating port system (SEPS) is a minimally invasive approach that can be performed under local anesthesia for the treatment of chronic subdural hematoma (CSDH). Subdural thrombolysis has been described as an exhaustive drainage strategy and found to be safe and effective for improving drainage. We aim to analyze the effectiveness of SEPS with subdural thrombolysis in patients older than 80 years.
Consecutive patients aged ≥80 years old who presented with symptomatic CSDH and underwent SEPS followed by subdural thrombolysis between January 2014 and February 2021 were retrospectively studied. Outcome measures included complications, mortality, recurrence, and modified Rankin Scale (mRS) scores at discharge and 3 months.
In total, 52 patients with CSDH in 57 hemispheres were operated on, with a mean age of 83.9 ± 3.3 years, and 40 (76.9%) patients were men. The preexisting medical comorbidities were observed in 39 patients (75.0%). Postoperative complications occurred in nine patients (17.3%), with two having significant complications (3.8%). The complications observed included pneumonia (11.5%), acute epidural hematoma (3.8%), and ischemic stroke (3.8%). One patient experienced contralateral malignant middle cerebral artery infarction and died of subsequent severe herniation, contributing to a perioperative mortality rate of 1.9%. Discharge and 3 months of favorable outcomes (mRS score 0-3) were achieved in 86.5% and 92.3% of patients, respectively. CSDH recurrence was observed in five patients (9.6%), and repeat SEPS was performed.
As an exhaustive drainage strategy, SEPS followed by thrombolysis is safe and effective with excellent outcomes among elderly patients. It is a technically easy and less invasive procedure with similar complications, mortality, and recurrence rates compared with burr-hole drainage in the literature.
硬膜下引流端口系统（SEPS）是一种可在局部麻醉下进行的微创方法，用于治疗慢性硬膜下血肿（CSDH）。硬膜下溶栓已被描述为一种彻底的引流策略，并且被发现对于改善引流是安全有效的。我们旨在分析SEPS联合硬膜下溶栓在80岁以上患者中的有效性。
回顾性研究2014年1月至2021年2月间连续收治的年龄≥80岁、表现为有症状CSDH且接受了SEPS并随后进行硬膜下溶栓的患者。结局指标包括并发症、死亡率、复发率以及出院时和3个月时的改良Rankin量表（mRS）评分。
总共对57个半球的52例CSDH患者进行了手术，平均年龄为83.9±3.3岁，40例（76.9%）为男性。39例患者（75.0%）存在既往合并症。9例患者（17.3%）发生术后并发症，其中2例出现严重并发症（3.8%）。观察到的并发症包括肺炎（11.5%）、急性硬膜外血肿（3.8%）和缺血性卒中（3.8%）。1例患者发生对侧恶性大脑中动脉梗死并死于随后的严重脑疝，导致围手术期死亡率为1.9%。分别有86.5%和92.3%的患者在出院时和3个月时获得良好结局（mRS评分0 - 3）。5例患者（9.6%）观察到CSDH复发，并进行了再次SEPS手术。
作为一种彻底的引流策略，SEPS联合溶栓在老年患者中是安全有效的，结局良好。与文献中的钻孔引流相比，它是一种技术上简单且侵入性较小的手术，并发症、死亡率和复发率相似。
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