Markwalder T M, Reulen H J
Acta Neurochir (Wien). 1986;79(2-4):100-6. doi: 10.1007/BF01407452.
The post-operative clinical course of a series of 201 patients with chronic subdural haematoma has been analyzed with respect to neomembranous organisation, cortical expansion and subdural pressure in the form of a prospective (53 cases) and retrospective (148 cases) study. With the exception of one patient (primary craniotomy and membranectomy) all other 200 cases were treated according to a standardized treatment protocol consisting of burr-hole craniotomy with (170 cases) or without (30 cases) closed-system drainage. Post-operative mortality (within one month after surgery) was 2%. There was a 4.5% recurrency rate and a 2% infection rate. Morbidity solely related to chronic subdural haematoma was 2% and was characterized by a mild neurological deficit. The level of subdural pressure had no influence on the post-operative clinical course, whereas marked intra-operative cerebral re-expansion favoured a more rapid clinical improvement. Although standard deviations were within a broad range, a nearly linear inverse relation could be assumed between the amount of peri-operative cerebral expansion and the degree of neomembranous organisation of the haematomas. Subdural neomembranes seem to represent the crucial opponents to cerebral re-expansion and they prolong the duration of neurological restitution.
通过前瞻性（53例）和回顾性（148例）研究，对201例慢性硬膜下血肿患者的术后临床过程进行了分析，涉及新膜形成、皮质扩张和硬膜下压力。除1例患者（初次开颅和膜切除术）外，其他200例均按照标准化治疗方案进行治疗，该方案包括钻孔开颅术，其中170例行闭式引流，30例未行闭式引流。术后死亡率（术后1个月内）为2%。复发率为4.5%，感染率为2%。仅与慢性硬膜下血肿相关的发病率为2%，表现为轻度神经功能缺损。硬膜下压力水平对术后临床过程无影响，而术中明显的脑再扩张有利于更快的临床改善。尽管标准差范围较宽，但可认为围手术期脑扩张量与血肿新膜形成程度之间存在近乎线性的反比关系。硬膜下新膜似乎是脑再扩张的关键阻碍因素，它们延长了神经功能恢复的时间。
