Miyata M, Yamasaki S, Iwai Y, Hirayama A, Tamaki N
Department of Neurosurgery, Takatsuki General Hospital.
No Shinkei Geka. 1994 Dec;22(12):1163-7.
A 61-year-old male who had been regularly hemodialyzed for a year and 8 months developed a double-loculated chronic subdural hematoma (CSDH). Computed tomography (CT) revealed a heterogenous-density hematoma at the right fronto-parietal convexity. After a burr hole aspiration and irrigation, CT disclosed a residual hematoma and a septum separating the hematoma cavities. The hematoma and the septum were removed by right frontal craniotomy. At surgery, it was found that the thick septum completely separated the hematoma cavities and the outside hematoma was made up of coagula containing trabecula-like structures, and the inside hematoma consisted of old bloody fluid. Histological examination showed that the outer membrane and the septum were both thick because of the invasion by numerous lymphocytes which suggested that the intramembraneous bleeding from sinusoids split the outer membrane of an old CSDH. Double or multi-loculated CSDH should be considered in a case which is slow in recovery or aggravated after a burr hole aspiration and irrigation.
一名61岁男性，已规律血液透析1年8个月，出现双腔慢性硬膜下血肿（CSDH）。计算机断层扫描（CT）显示右额顶叶凸面有一密度不均匀的血肿。在进行钻孔抽吸和冲洗后，CT显示有残余血肿以及分隔血肿腔的隔膜。通过右额开颅手术切除了血肿和隔膜。手术中发现，厚隔膜完全分隔了血肿腔，外部血肿由含有小梁样结构的凝血块组成，内部血肿由陈旧血性液体构成。组织学检查显示，由于大量淋巴细胞浸润，外膜和隔膜均增厚，这提示窦状隙的膜内出血使陈旧性CSDH的外膜裂开。对于钻孔抽吸和冲洗后恢复缓慢或病情加重的病例，应考虑双腔或多腔CSDH。
