Hamilton M G, Frizzell J B, Tranmer B I
University of Calgary, Department of Clinical Neurosciences, Alberta, Canada.
Neurosurgery. 1993 Jul;33(1):67-72. doi: 10.1227/00006123-199307000-00010.
The management of chronic subdural hematoma in the adult patient is approached with a variety of different surgical techniques. The trend in recent years has been toward treatment with burr holes or twist-drill holes rather than craniotomy. The rationale for this has been based on the assumption that burr holes and twist-drill holes offer equivalent efficacy and lower morbidity and mortality. This viewpoint is not, however, universally accepted, and many surgeons feel that craniotomy is superior to a burr hole for the management of this condition. In a review of 92 patients presenting over a 3-year period with 112 chronic subdural hematomas, 49 underwent craniotomy and 43 underwent burr-hole treatment. The recurrence of hematomas, requiring another operation, occurred in 8.6%; operative mortality was 2.2% at hospital discharge and 4.4% at follow-up. No patient died as a consequence of the operative procedure. There was no significant difference in the incidence of postoperative complications, hematoma recurrence, or operative mortality among the different surgical groups. Previous reports concerning the superiority of burr holes over craniotomy are not substantiated by this review. Although the issue concerning optimal therapy has not been resolved by this review, at this time, craniotomy remains a valid and safe technique for the management of patients with chronic subdural hematoma.
成年患者慢性硬膜下血肿的治疗采用了多种不同的手术技术。近年来的趋势是采用钻孔或锥颅钻孔治疗而非开颅手术。这样做的理论依据是基于钻孔和锥颅钻孔具有同等疗效且发病率和死亡率较低的假设。然而，这种观点并未被普遍接受，许多外科医生认为开颅手术在治疗这种疾病方面优于钻孔术。在一项对92例患者（在3年期间出现112例慢性硬膜下血肿）的回顾中，49例行开颅手术，43例行钻孔治疗。需要再次手术的血肿复发率为8.6%；出院时手术死亡率为2.2%，随访时为4.4%。没有患者因手术操作而死亡。不同手术组之间术后并发症、血肿复发或手术死亡率的发生率没有显著差异。此次回顾并未证实先前关于钻孔术优于开颅手术的报道。尽管此次回顾并未解决最佳治疗方法的问题，但目前，开颅手术仍然是治疗慢性硬膜下血肿患者的一种有效且安全的技术。
