Markwalder T M, Steinsiepe K F, Rohner M, Reichenbach W, Markwalder H
J Neurosurg. 1981 Sep;55(3):390-6. doi: 10.3171/jns.1981.55.3.0390.
A consecutive series of 32 adult patients with chronic subdural hematoma was studied in respect to postoperative cerebral reexpansion (reduction in diameter of the subdural space) after burr-hole craniostomy and closed-system drainage. Patients with high subdural pressure showed the most rapid brain expansion and clinical improvement during the first 2 days. Nevertheless, a computerized tomography (CT) scan performed on the 10th day after surgery demonstrated persisting subdural fluid in 78% of cases. After 40 days, the CT scan was normal in 27 of the 32 patients. There was no mortality and no significant morbidity. Our study suggests that well developed subdural neomembranes are the crucial factors for cerebral reexpansion, a phenomenon that takes at least 10 to 20 days. However, blood vessel dysfunction and impairment of cerebral blood flow may participate in delay of brain reexpansion. It may be argued that additional surgical procedures, such as repeated tapping of the subdural fluid, craniotomy, and membranectomy or even craniectomy, should not be evaluated earlier than 20 days after the initial surgical procedure unless the patient has deteriorated markedly.
对连续32例成年慢性硬膜下血肿患者进行了研究，观察钻孔开颅和闭式引流术后的脑再膨胀情况（硬膜下腔直径缩小）。硬膜下压力高的患者在术后头2天脑膨胀最快，临床症状改善也最明显。然而，术后第10天进行的计算机断层扫描（CT）显示，78%的病例存在持续的硬膜下积液。40天后，32例患者中有27例CT扫描结果正常。无死亡病例，也无明显的并发症。我们的研究表明，发育良好的硬膜下新膜是脑再膨胀的关键因素，这一现象至少需要10至20天。然而，血管功能障碍和脑血流受损可能参与了脑再膨胀的延迟。可以认为，除非患者病情明显恶化，否则在初次手术后20天内不应评估额外的手术操作，如反复抽取硬膜下积液、开颅手术、膜切除术甚至颅骨切除术。
