Quinones Christian, Wilson John Preston, Kumbhare Deepak, Sin Anthony, Guthikonda Bharat, Hoang Stanley
Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana.
J Neurosurg Case Lessons. 2024 Dec 30;8(27). doi: 10.3171/CASE24541.
Parafalcine subdural hematomas (pSDHs) are a subtype of subdural hematoma (SDH) that occur most frequently in older patients after blunt trauma. The literature primarily describes two clinical courses for patients with pSDH: those who are neurologically intact with stable examinations and imaging and those with focal deficits, with or without hematoma progression. Surgical management is undoubtedly required for the latter group; however, there are no evidence-based guidelines specifically for pSDH. This report describes the cases of two patients with traumatic pSDH with neurological deficits who underwent surgical interventions with two different approaches and advocates for the use of stereotactic navigation to achieve adequate evacuation.
In the first case, a 55-year-old male with a parafalcine and convexity SDH underwent a hemicraniectomy, followed by a second surgery for evacuation of the residual pSDH due to a persistent neurological deficit. The second case involved an 84-year-old female with a parafalcine and convexity SDH, who underwent surgical evacuation of the pSDH with the aid of stereotactic navigation.
Approaching the surgical evacuation of a pSDH as if it were a mass lesion led to the use of intraoperative navigation, which resulted in superior localization and complete evacuation, ultimately improving patient outcomes. https://thejns.org/doi/10.3171/CASE24541.
大脑镰旁硬膜下血肿（pSDH）是硬膜下血肿（SDH）的一种亚型，最常见于老年患者遭受钝性创伤后。文献主要描述了pSDH患者的两种临床病程：神经系统检查和影像学表现稳定且无神经功能缺损的患者，以及有局灶性神经功能缺损、伴或不伴有血肿进展的患者。对于后一组患者，手术治疗无疑是必要的；然而，目前尚无专门针对pSDH的循证指南。本报告描述了两名患有创伤性pSDH且伴有神经功能缺损的患者的病例，这两名患者采用了两种不同的方法进行手术干预，并主张使用立体定向导航以实现充分的血肿清除。
在第一例病例中，一名55岁男性患有大脑镰旁及脑凸面SDH，接受了去骨瓣减压术，由于持续存在神经功能缺损，随后进行了第二次手术以清除残留的pSDH。第二例病例涉及一名84岁女性，患有大脑镰旁及脑凸面SDH，在立体定向导航辅助下接受了pSDH的手术清除。
将pSDH的手术清除视为肿块样病变，从而采用术中导航，实现了更好的定位和完全清除，最终改善了患者的预后。https://thejns.org/doi/10.3171/CASE24541。
