Lee Gyubin, Jang Yeongyu, Whang Kum, Cho Sungmin, Kim Jongyeon, Kim Byeongoh, Choi Jongwook
Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
Department of Neurosurgery, Konkuk University Chungju Hospital, Chungju, Korea.
Korean J Neurotrauma. 2023 Sep 25;19(3):324-332. doi: 10.13004/kjnt.2023.19.e51. eCollection 2023 Sep.
Chronic subdural hematoma (CSDH) is a commonly encountered neurosurgical pathology that frequently requires surgical intervention. With an increasingly aging demographic, more older people and patients with comorbidities will present with symptomatic CSDH. This study evaluated clinical and laboratory factors affecting the short-term outcomes of CSDH after surgical intervention.
We retrospectively analyzed 170 patients who underwent burr-hole trephination for CSDH in a single institution from January 2019 to December 2021. All patients were examined for risk factors and evaluated for hematoma thickness change and midline shifting on brain computed tomography (CT) scans at 3 days after burr-hole trephination.
This consecutive series of patients included 114 males (67.1%) and 56 females (32.9%); mean age 72.4±12.5 years. Renal disease (=0.044) and prior intracranial hemorrhage (=0.004) were clinical factors associated with poorer prognosis. A statistically significant association was found between initial laboratory findings, including high creatine kinase (=0.025) and low platelet (=0.036) levels, and CT findings 3 days postoperatively. The 3-day mean arterial pressure and postoperative ambulation were not significantly associated with outcomes.
Burr-hole craniostomy is an effective surgical procedure for initial CSDH. However, patients with a history intracranial hemorrhage and abnormal laboratory findings, such as low platelet levels, who underwent burr-hole trephination had poor short-term outcomes. Therefore, these patients should be carefully monitored.
慢性硬膜下血肿（CSDH）是一种常见的神经外科疾病，常需手术干预。随着人口老龄化加剧，越来越多的老年人和合并症患者将出现有症状的CSDH。本研究评估了影响手术干预后CSDH短期预后的临床和实验室因素。
我们回顾性分析了2019年1月至2021年12月在单一机构接受钻孔引流术治疗CSDH的170例患者。所有患者均检查危险因素，并在钻孔引流术后3天通过脑部计算机断层扫描（CT）评估血肿厚度变化和中线移位。
这一系列连续患者包括114名男性（67.1%）和56名女性（32.9%）；平均年龄72.4±12.5岁。肾病（=0.044）和既往颅内出血（=0.004）是与预后较差相关的临床因素。在初始实验室检查结果（包括高肌酸激酶水平（=0.025）和低血小板水平（=0.036））与术后3天的CT检查结果之间发现了统计学上的显著关联。术后3天的平均动脉压和术后活动与预后无显著关联。
钻孔开颅术是治疗初始CSDH的有效手术方法。然而，有颅内出血病史且实验室检查结果异常（如血小板水平低）的患者，接受钻孔引流术后短期预后较差。因此，应对这些患者进行密切监测。
