Habib Hosam-Eldin Abd-Elazim, Elnoamany Hossam, Elnaggar Ahmed Gabry
Department of Neurosurgery, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt.
Surg Neurol Int. 2024 Aug 16;15:288. doi: 10.25259/SNI_363_2024. eCollection 2024.
Chronic subdural hematoma (CSDH) is a collection of blood, blood degradation products, and fluid that accumulate on the surface of the brain between its arachnoid and dural coverings. This study is to evaluate the efficacy of subgaleal drain (SGD) versus subgaleal dissection without drainage as adjuncts to burr-hole evacuation of CSDH.
A retrospective study was conducted utilizing the data of 60 patients operated for symptomatic CSDH. Patients were divided into two groups, each thirty consecutive patients: Group I, in which a SGD was inserted after CSDH evacuation through a burr-hole; and Group II, the hematoma was evacuated as in the Group I, but with no SGD insertion but instead a subgaleal pocket was created for drainage.
The neurological improvement at 24 h, discharge, 2 weeks, and 6 months after surgery was comparable in both groups. The overall recurrence was 4 cases (4/60, 6.7%). The rate of recurrence and surgical infection rate were comparable in both groups. Both groups showed similar incidences of postoperative seizures, bleeding, rates of medical complications, and neurological deficits. The overall postoperative mortality was five cases (5/60, 8.3%) with no significant difference between groups.
Blunt dissection to open the subgaleal space and closure without a drain is a safe and efficient alternative to the insertion of a drain after the burr-hole evacuation of CSDH.
慢性硬膜下血肿（CSDH）是血液、血液降解产物和液体在脑蛛网膜和硬脑膜之间的脑表面积聚形成的。本研究旨在评估帽状腱膜下引流（SGD）与不引流的帽状腱膜下分离作为CSDH钻孔引流辅助手段的疗效。
利用60例有症状CSDH手术患者的数据进行回顾性研究。患者分为两组，每组连续30例：第一组，通过钻孔引流CSDH后插入SGD；第二组，与第一组一样进行血肿引流，但不插入SGD，而是创建一个帽状腱膜下腔用于引流。
两组术后24小时、出院时、2周和6个月时的神经功能改善情况相当。总复发率为4例（4/60，6.7%）。两组的复发率和手术感染率相当。两组术后癫痫发作、出血、医疗并发症发生率和神经功能缺损发生率相似。术后总死亡率为5例（5/60，8.3%），两组间无显著差异。
钝性分离打开帽状腱膜下间隙并在不放置引流管的情况下闭合，是CSDH钻孔引流后插入引流管的一种安全有效的替代方法。
