Kim You-Sub, Joo Sung-Pil, Ahn Kang-Hee, Kim Tae-Sun
Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
J Clin Neurosci. 2024 Mar;121:77-82. doi: 10.1016/j.jocn.2024.02.005. Epub 2024 Feb 16.
The timing and decision to drain subdural hematoma (SDH) in spontaneous intracranial hypotension (SIH) remains a dilemma. We reviewed our experience of bilateral SDH secondary to SIH, focusing on decision making and treatment strategies.
We retrospectively reviewed bilateral SDH secondary to SIH between March 2010 and September 2021. Baseline characteristics of patients, diagnosis, radiologic findings, treatments, and clinical outcome were investigated.
Fifteen patients (7 men, 8 women) with bilateral SDH secondary to SIH were included in this study. Initially, patients were treated conservatively (4 patients, 26.7 %), with an epidural blood patch (EBP, 3 patients, 20.0 %), and SDH drainage followed by the Trendelenburg position (8 patients, 53.3 %). All 3 patients that were initially treated with EBP required SDH drainage. Of the 8 patients initially treated with SDH drainage via burr hole followed by Trendelenburg position, 7 patients showed sustained improvements without EBP; however, 1 patient needed EBP. Deterioration to coma occurred in 6 out of 15 patients (40.0 %). All 6 deteriorated patients immediately recovered after SDH drainage with Trendelenburg position; 5 achieved sustained improvement without EBP and 1 required EBP. During the follow-up period, 14 out of 15 patients (93.3 %) showed good recovery.
Evacuation of SDH is not always necessary in SIH; however, we did not hesitate to perform hematoma drainage, in deteriorated patients or those with thick hematoma that is associated with significant sagging and cistern effacement. This can prevent irreversible neurologic complications. Moreover, the Trendelenburg position may help to achieve sustained improvement without additional treatment.
对于自发性颅内低压（SIH）所致硬膜下血肿（SDH）的引流时机及决策仍存在争议。我们回顾了SIH继发双侧SDH的治疗经验，重点关注决策制定和治疗策略。
我们回顾性分析了2010年3月至2021年9月期间SIH继发双侧SDH的病例。对患者的基线特征、诊断、影像学表现、治疗方法及临床结局进行了研究。
本研究纳入了15例SIH继发双侧SDH的患者（7例男性，8例女性）。最初，4例患者（26.7%）接受保守治疗，3例患者（20.0%）接受硬膜外血贴（EBP）治疗，8例患者（53.3%）接受SDH引流并采用头低脚高位。最初接受EBP治疗的3例患者均需进行SDH引流。最初8例通过钻孔引流SDH并采用头低脚高位治疗的患者中，7例未行EBP即持续好转；然而，1例患者需要EBP。15例患者中有6例（40.0%）病情恶化至昏迷。所有6例病情恶化的患者在SDH引流并采用头低脚高位后立即恢复；5例未行EBP即持续好转，1例需要EBP。随访期间，15例患者中有14例（93.3%）恢复良好。
SIH患者并非总是需要进行SDH引流；然而，对于病情恶化的患者或血肿较厚且伴有明显脑下垂和脑池消失的患者，我们毫不犹豫地进行血肿引流。这可以预防不可逆的神经并发症。此外，头低脚高位可能有助于在无需额外治疗的情况下实现持续好转。
