Kweon Su-Bin, Kim Suchel, Kwon Min-Yong, Kim Chang-Hyun, Kwon Sae Min, Ko Yong San, Lee Chang-Young
Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
J Cerebrovasc Endovasc Neurosurg. 2023 Dec;25(4):390-402. doi: 10.7461/jcen.2023.E2023.04.017. Epub 2023 Aug 14.
Chronic subdural hematoma (CSDH) is a neurological complication following clipping surgery. However, the natural course and ideal approach for the treatment of clipping-related-CSDH (CR-CSDH) have not been clearly established. We aimed to investigate the course of CR-CSDH using chronological radiological findings.
We performed a retrospective analysis of 28 (3.8%) patients who developed CSDH among 736 patients who underwent surgical clipping using pterional approach for unruptured aneurysms at our institution between December 2010 and December 2018. Patients underwent follow-up CT scan 6-8 weeks after clipping surgery and decision to pursue surgical intervention rests upon the patient's symptom based on the Markwalder's grading scale (MGS) and numeric rating scale (NRS).
Of the 28 patients, 3 patients (10.7%) underwent surgery, while 25 (89.2%) showed spontaneous resolution of CR-CSDH. Eighteen patients (64.2%) had mild headache with MGS of 0-1. The mean maximum hematoma volume was 41.9±30.9 ml (5.8-135 ml), and 26 patients (92.8%) had homogeneous hematoma. The mean time to hematoma resolution was 126.7±52.9 days (46-228 days). Comparing group of CR-CSDH volume ≥43 ml or a midline shift ≥5 mm, the difference in presence of linear low-density area (p=0.002) and age (p=0.026) between the conservative and operative groups were found to be statistically significant.
Most CR-CSDH cases spontaneously resolved within 4 months. Therefore, we suggest that close observation should be performed if patient's symptoms are mild and special radiologic findings are present, despite its relatively large volume and midline shifting.
慢性硬膜下血肿（CSDH）是夹闭手术后的一种神经并发症。然而，与夹闭相关的慢性硬膜下血肿（CR-CSDH）的自然病程和理想治疗方法尚未明确确立。我们旨在利用按时间顺序排列的影像学检查结果来研究CR-CSDH的病程。
我们对2010年12月至2018年12月期间在我院接受翼点入路手术夹闭未破裂动脉瘤的736例患者中发生CSDH的28例（3.8%）患者进行了回顾性分析。患者在夹闭手术后6-8周接受随访CT扫描，并根据Markwalder分级量表（MGS）和数字评分量表（NRS），依据患者症状决定是否进行手术干预。
28例患者中，3例（10.7%）接受了手术，而25例（89.2%）的CR-CSDH表现为自发消退。18例患者（64.2%）有轻度头痛，MGS为0-1级。血肿最大平均体积为41.9±30.9 ml（5.8-135 ml），26例患者（92.8%）为均匀血肿。血肿消退的平均时间为126.7±52.9天（46-228天）。比较CR-CSDH体积≥43 ml或中线移位≥5 mm的组，保守治疗组和手术治疗组之间线性低密度区的存在情况（p=0.002）和年龄（p=0.026）差异有统计学意义。
大多数CR-CSDH病例在4个月内自发消退。因此，我们建议，如果患者症状较轻且存在特殊影像学表现，尽管血肿体积相对较大且有中线移位，也应进行密切观察。
