Liu Yuchen, Yang Tianquan, Sun Jingxuan, Han Yong, Yuan Bin, Xiang Yongjun, Zhou Ruxuan, Chen Min, Wang Hangzhou
Department of Neurosurgery, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215006, China.
Neurosurg Rev. 2025 Mar 27;48(1):332. doi: 10.1007/s10143-025-03482-5.
The existing literature on subdural hematomas (SDH) primarily focused on surgically treated cases. However, minor SDH remain unexplored. This study aims to investigate the association between subarachnoid space depth and neurosurgical intervention in children with minor SDH. Patients (age < 3 years) with minor SDH between June 2015 and June 2024 at the Children's Hospital of Soochow University were included. Patients with subarachnoid space depth ≥ 3 mm were classified into the ESS group. In total, 277 patients with minor SDH were included, of whom 100 (36.1%) had ESS. During conservative observation, 22 (7.94%) patients received a neurosurgical intervention. Patients with ESS had an adjusted odds ratio (OR) of 6.07 (95% CI: 1.57-23.4; p = 0.009) for receiving neurosurgical intervention. In subgroup analyses, the subarachnoid space depth was associated with the neurosurgical intervention in patients who were male (OR = 7.33; 95% CI: 1.96-27.39), infants (OR = 5.84; 95% CI: 1.63-20.85), those with an open fontanelle (OR = 4.92; 95% CI: 1.57-15.41), and those without a history of seizures (OR = 5.87; 95% CI: 1.81-19.03). The association was robust in sensitivity analyses. Subdural hematohygroma significantly mediated the association (p = 0.016), accounting for 16.79% of the correlation. The subarachnoid space depth may be a significant risk factor for neurosurgical intervention during conservative observation in children, particularly infants, with minor SDH.
现有的关于硬膜下血肿（SDH）的文献主要集中在手术治疗的病例上。然而，轻度SDH仍未得到充分研究。本研究旨在探讨蛛网膜下腔深度与轻度SDH患儿神经外科干预之间的关联。纳入了2015年6月至2024年6月期间苏州大学附属儿童医院患有轻度SDH的患者（年龄<3岁）。蛛网膜下腔深度≥3mm的患者被归类为ESS组。总共纳入了277例轻度SDH患者，其中100例（36.1%）有ESS。在保守观察期间，22例（7.94%）患者接受了神经外科干预。ESS患者接受神经外科干预的调整优势比（OR）为6.07（95%CI：1.57 - 23.4；p = 0.009）。在亚组分析中，蛛网膜下腔深度与男性患者（OR = 7.33；95%CI：1.96 - 27.39）、婴儿（OR = 5.84；95%CI：1.63 - 20.85）、囟门未闭的患者（OR = 4.92；95%CI：1.57 - 15.41）以及无癫痫病史的患者（OR = 5.87；95%CI：1.81 - 19.03）的神经外科干预相关。在敏感性分析中，这种关联是稳健的。硬膜下积血囊肿显著介导了这种关联（p = 0.016），占相关性的16.79%。蛛网膜下腔深度可能是轻度SDH患儿，尤其是婴儿，在保守观察期间进行神经外科干预的一个重要危险因素。
