Trinidad Leo E, Orata Rhoby U
Neurosurgery Service, Department of Surgery, Victoriano Luna Medical Center, Armed Forces of the Philippines, Quezon City, Philippines.
J Korean Neurosurg Soc. 2025 Jul;68(4):465-472. doi: 10.3340/jkns.2024.0099. Epub 2024 Oct 25.
Subdural hematomas (SDHs) are classified clinically and/or radiologically as acute SDH (ASDH), subacute SDH (SSDH), and chronic SDH (CSDH). The management differ depending on their classification, with only the ASDH having a definite accepted surgical guideline. Non-acute SDH, specifically SSDH and CSDH have no clear surgical guidelines but are managed similarly in some literature. This study was conducted to determine if there is a difference in outcomes among surgically managed non-acute SDH in a specific elderly population of retired military personnel.
This is a pre-pandemic retrospective study that utilized data obtained from January 2016 to April 2019, in a subspecialty tertiary hospital that caters to retired military personnel or veterans, in the Philippines. After chart review and application of inclusion and exclusion criteria, 21 patients were included, all military retirees, with age 56 years old and above. Chart review and electronic database were retrieved to extract relevant information.
In this study, a term 'mixed-type subdural hematoma' (MSDH) was proposed to encompass SDH that have mixed hypo-andhyperdensity on preoperative computed tomography scan and were subsequently found to have bright red liquefied hematoma instead of the classic engine machinery oil fluid found in a CSDH. Based on the observed cohort, nine out of 11 CSDH patients attained the Glasgow outcome scale extended (GOS-E) score of 8 while all the respondents in the MSDH group attained the same GOS-E score underscoring the need for early intervention in patients with non-acute SDH. Moreover, the outcomes of both MSDH and CSDH are comparable with low mortality rate (approximately 9.5%) and immediate postoperative improvement (approximately 90%).
MSDH and CSDH, although classified separately using clinical and/or radiologic means, can collectively be categorized as a non-acute SDH and can be managed safely and effectively with burr hole surgery.
硬膜下血肿（SDH）在临床和/或放射学上分为急性硬膜下血肿（ASDH）、亚急性硬膜下血肿（SSDH）和慢性硬膜下血肿（CSDH）。其治疗方法因分类不同而有所差异，只有ASDH有明确公认的手术指南。非急性SDH，特别是SSDH和CSDH没有明确的手术指南，但在一些文献中治疗方式相似。本研究旨在确定在特定的老年退休军人人群中，手术治疗的非急性SDH患者的预后是否存在差异。
这是一项疫情前的回顾性研究，利用了2016年1月至2019年4月在菲律宾一家为退休军人或退伍军人服务的三级专科医院获得的数据。在进行病历审查并应用纳入和排除标准后，纳入了21名患者，均为退休军人，年龄在56岁及以上。通过病历审查和检索电子数据库来提取相关信息。
在本研究中，提出了“混合型硬膜下血肿”（MSDH）这一术语，以涵盖术前计算机断层扫描显示有混合低密度和高密度影，且随后发现有鲜红色液化血肿而非CSDH中典型的机油样液体的SDH。基于观察队列，11例CSDH患者中有9例获得了扩展格拉斯哥预后量表（GOS-E）评分8分，而MSDH组的所有受试者均获得了相同的GOS-E评分，突出了对非急性SDH患者进行早期干预的必要性。此外，MSDH和CSDH的预后相当，死亡率低（约9.5%），术后即刻改善率高（约90%）。
MSDH和CSDH虽然通过临床和/或放射学方法单独分类，但可统称为非急性SDH，采用钻孔手术可安全有效地进行治疗。
