Mathew P, Oluoch-Olunya D L, Condon B R, Bullock R
Department of Neurosurgery, Southern General Hospital, Glasgow, U.K.
Acta Neurochir (Wien). 1993;121(3-4):100-8. doi: 10.1007/BF01809258.
We have retrospectively reviewed 23 conscious patients, in whom a CT scan diagnosis of acute subdural haematoma was made, and in whom craniotomy for evacuation was not initially performed. These highly selected patients represent 3% of 837 patients with acute subdural haematoma, presenting over a five year, eight month period to the Institute of Neurological Sciences, in Glasgow (1986-1991). Patients with any other associated intracranial abnormalities, such as cerebral contusions, as shown on CT, were excluded from this report. All patients were followed by serial CT scanning, and neurological assessments. Cerebral atrophy was present in over half of the sample. In 17 of our patients, the acute subdural haematoma resolved spontaneously, without evidence of damage to the underlying brain, as shown by CT or neurological findings. Six subsequently required burr hole drainage of a hypodense liquid subdural haematoma. In each of these patients, haematoma thickness was greater than 10 mm. Haematoma volume was significantly larger (53 +/- 6 ml versus 32 +/- 2 ml) in the group who came to operation. The mean delay between injury and operation in this group was 15 days. We conclude that certain conscious patients with small acute subdural haematomas, without mass effect on CT, may be safely managed conservatively.
我们回顾性研究了23例清醒患者，这些患者经CT扫描诊断为急性硬膜下血肿，且最初未进行开颅血肿清除术。这些经过严格筛选的患者占837例急性硬膜下血肿患者的3%，这837例患者在1986年至1991年的五年零八个月期间就诊于格拉斯哥神经科学研究所。本报告排除了CT显示有任何其他相关颅内异常（如脑挫裂伤）的患者。所有患者均接受了系列CT扫描和神经功能评估。超过半数的样本存在脑萎缩。在我们的17例患者中，急性硬膜下血肿自发消退，CT或神经功能检查均未显示对其下方脑组织有损伤迹象。6例患者随后需要通过钻孔引流术治疗低密度液性硬膜下血肿。在这些患者中，血肿厚度均大于10mm。手术组的血肿体积明显更大（53±6ml对32±2ml）。该组患者受伤至手术的平均间隔时间为15天。我们得出结论，某些清醒的急性硬膜下小血肿患者，若CT上无占位效应，可安全地进行保守治疗。
