Penchet G, Loiseau H, Castel J P
Clinique Universitaire de Neurochirurgie, Hôpital Pellegrin, Bordeaux.
Neurochirurgie. 1998 Nov;44(4):247-52.
Are chronic bilateral subdural hematomas different from unilateral forms in terms of delay of diagnosis, clinical presentation and post-operative recovery or recurrence?
Etiological, clinical, and radiological aspects and management outcome of bilateral chronic subdural hematomas consecutively managed from 1990 to 1995 were retrospectively analyzed and compared with unilateral forms managed in the same neurosurgical unit during the same period of time.
There were 236 cases. Bilateral subdural hematomas occurred in 41 patients (17.4%). A good outcome was obtained in 97.5% of the cases and morbidity was 14.6%. The differences significantly observed between unilateral and bilateral subdural hematomas were duration of the prediagnostic period, pneumatoceles and recurrence rates (12%). Recurrences were all observed during the first postoperative month and treated with the same initial standardized procedure. The rate of infection or epileptic seizures was low.
There are few limited differences between uni- and bilateral chronic subdural hematomas. In the latter, a possible correlation between the duration of prediagnostic period and an increased rate of recurrence could be explained by poorer cerebral reexpansion. The overall prognosis of bilateral hematomas is comparable with that observed in unilateral forms. A simple and routinely used burr hole procedure either under local or general anesthesia associated with closed drainage is a safe surgical procedure for either bilateral or unilateral forms and can be performed in all the cases including recurrences. Systematic antiepileptic drugs or antibiotherapy are unnecessary in the medical management of chronic subdural hematomas. One late delayed postoperative clinical control seems to be sufficient.
慢性双侧硬膜下血肿在诊断延迟、临床表现、术后恢复或复发方面是否与单侧硬膜下血肿不同？
回顾性分析1990年至1995年连续治疗的双侧慢性硬膜下血肿的病因、临床、影像学方面及治疗结果，并与同期在同一神经外科治疗的单侧硬膜下血肿进行比较。
共236例患者。双侧硬膜下血肿41例（17.4%）。97.5%的病例预后良好，发病率为14.6%。单侧和双侧硬膜下血肿之间显著观察到的差异在于诊断前期的持续时间、气囊肿和复发率（12%）。所有复发均在术后第一个月内观察到，并采用相同的初始标准化程序进行治疗。感染或癫痫发作率较低。
单侧和双侧慢性硬膜下血肿之间存在一些有限的差异。在双侧慢性硬膜下血肿中，诊断前期持续时间与复发率增加之间可能存在的相关性可以用脑再膨胀较差来解释。双侧血肿的总体预后与单侧血肿相当。局部或全身麻醉下结合闭式引流的简单且常规使用的钻孔手术对于双侧或单侧血肿都是一种安全的手术方法，并且可以在包括复发在内的所有病例中进行。在慢性硬膜下血肿的药物治疗中，系统性抗癫痫药物或抗生素治疗是不必要的。术后一次晚期延迟临床检查似乎就足够了。
