Rao Gollapudi Prakash, Imran Mohammed, Raju Reddycherla Naga, Sandeep Pittala, Reddy Kotha Arjun
Department of Neurosurgery, Gandhi Medical College, Secunderabad, Telangana, India.
Department of Neurosurgery, Srikara Hospitals, Hyderabad, Telangana, India.
Asian J Neurosurg. 2024 May 13;19(2):256-262. doi: 10.1055/s-0044-1786703. eCollection 2024 Jun.
Chronic subdural hematoma (SDH) is one of the most common conditions encountered in the neurosurgical practice. Surgical modalities like twist drill craniostomy, burr hole evacuation, mini-craniotomy, and craniotomy are practiced in the management of chronic SDH. Mini-craniotomy without excision of membranes may help to achieve best results with decreased complication rate. Patients with chronic SDH operated from September 2013 to September 2022 were included in the study. Mini-craniotomy (40-60 mm) was done and cruciate incision was given over the dura. Dura was left wide open by reflecting and suturing the cut edges of the dural leaflets to the craniotomy edge allowing to evacuate subdural space under vision during surgery and to allow any residual collection to drain out freely in the postoperative period. A drain was placed between the inner membrane and the bone flap. Preoperative and postoperative clinical and radiological parameters were recorded. Complications, recurrence, and residual collections were noted. Seventy-seven patients were included in the study. Mean age was 57.32 years. Median Glasgow Coma Scale (GCS) at presentation was 13 while median GCS at discharge was 15. Two patients with preexisting comorbidities expired after surgery due to medical causes. No recurrences were noted. Fourteen patients had residual collections which resolved by 6 weeks. Two patients had wound infection. One of these patients later needed a bone flap removal due to osteomyelitis. Mini-craniotomy without membranectomy is a good option for complete evacuation of chronic SDH under vision mainly avoiding the complication of membranectomy. It is not associated with increased complications rate. It needs fewer follow-ups as brain expansion can be established radiologically in a short period.
慢性硬膜下血肿（SDH）是神经外科实践中最常见的病症之一。在慢性SDH的治疗中，采用了诸如钻颅引流术、钻孔引流术、微创开颅术和开颅术等手术方式。不切除包膜的微创开颅术可能有助于获得最佳效果并降低并发症发生率。
纳入研究的患者为2013年9月至2022年9月接受手术治疗的慢性SDH患者。进行了40 - 60毫米的微创开颅术，并在硬脑膜上做十字形切口。通过将硬脑膜小叶的切缘反射并缝合到开颅边缘，使硬脑膜保持敞开，以便在手术过程中直视下排空硬膜下腔，并使任何残留的血肿在术后自由引流。在内膜和骨瓣之间放置引流管。记录术前和术后的临床及影像学参数。记录并发症、复发情况和残留血肿。
该研究纳入了77例患者。平均年龄为57.32岁。入院时格拉斯哥昏迷量表（GCS）中位数为13，出院时GCS中位数为15。两名患有基础合并症的患者术后因医疗原因死亡。未发现复发情况。14例患者有残留血肿，这些血肿在6周内消退。2例患者发生伤口感染。其中1例患者后来因骨髓炎需要进行骨瓣切除。
不切除包膜的微创开颅术是在直视下完全排空慢性SDH的良好选择，主要避免了切除包膜的并发症。它不会增加并发症发生率。由于可以在短时间内通过影像学确定脑膨出情况，因此随访次数较少。
