Tsutsumi K, Maeda K, Iijima A, Usui M, Okada Y, Kirino T
Department of Neurosurgery, Aizu Chuou Hospital, Aizuwakamatsu, Fukushima, Japan.
J Neurosurg. 1997 Dec;87(6):870-5. doi: 10.3171/jns.1997.87.6.0870.
Although chronic subdural hematoma (CSDH) is a well-known entity, its recurrence rate has remained uncertain. There is little knowledge concerning whether the results of radiological imaging can be used to predict CSDH recurrence or whether surgical methods can influence this rate. The first aim of this study is to evaluate the relationship between the recurrence rate of CSDHs and their appearance on preoperative magnetic resonance (MR) or computerized tomography images. The second aim is to evaluate by means of a prospective randomized method the usefulness of closed-system drainage. From January 1988 through June 1996, the authors surgically treated 257 consecutive adult patients with CSDHs. Data obtained in 199 patients who were evaluated preoperatively by MR imaging were analyzed. Thirty-one of these patients underwent bilateral operations and thus 230 operative sites of CSDH were included in the analyses. The cases of CSDH were separated into high- and nonhigh-intensity groups on the basis of the appearance on T1-weighted MR images. From July 1992 to June 1996, the authors conducted a prospective randomized study on the recurrence rate of CSDH in patients undergoing burr-hole irrigation with or without closed system drainage. The recurrence rate of 3.4% in the high-intensity group was significantly lower than the 11.6% rate found in the nonhigh-intensity group (p < 0.05). The recurrence rates following irrigation with and without closed system drainage were significantly different (p < 0.025): 3.1% with closed system drainage and 17% following burr-hole irrigation alone. The surgical procedures were correlated with the MR findings. In the high-intensity group, 1.1% of CSDHs recurred in patients in whom closed system drainage was used and 11.1% in patients without closed system drainage. In the nonhigh-intensity group, 8.1% of CSDHs recurred in patients in whom drainage was used and 23.1% in patients without closed system drainage. Magnetic resonance T1-weighted imaging was useful in predicting the propensity of CSDHs to recur. Closed system drainage significantly reduced the recurrence rate of CSDHs regardless of MR findings.
尽管慢性硬膜下血肿（CSDH）是一种广为人知的病症，但其复发率仍不确定。关于放射影像学结果是否可用于预测CSDH复发，或手术方法是否会影响该复发率，目前知之甚少。本研究的首要目的是评估CSDH复发率与其术前磁共振成像（MR）或计算机断层扫描图像表现之间的关系。第二个目的是通过前瞻性随机方法评估闭式引流的有效性。从1988年1月至1996年6月，作者对257例连续的成年CSDH患者进行了手术治疗。对199例术前接受MR成像评估的患者所获得的数据进行了分析。其中31例患者接受了双侧手术，因此230个CSDH手术部位纳入了分析。根据T1加权MR图像表现，将CSDH病例分为高强度组和非高强度组。从1992年7月至1996年6月，作者对接受钻孔冲洗且有或无闭式引流的患者的CSDH复发率进行了前瞻性随机研究。高强度组3.4%的复发率显著低于非高强度组11.6%的复发率（p<0.05）。有闭式引流和无闭式引流冲洗后的复发率有显著差异（p<0.025）：闭式引流为3.1%，单纯钻孔冲洗为17%。手术方式与MR表现相关。在高强度组中，使用闭式引流的患者CSDH复发率为1.1%，未使用闭式引流的患者为11.1%。在非高强度组中，使用引流的患者CSDH复发率为8.1%，未使用闭式引流的患者为23.1%。磁共振T1加权成像有助于预测CSDH的复发倾向。无论MR表现如何，闭式引流均显著降低了CSDH的复发率。
