神经内镜下钻孔冲洗术治疗老年人慢性硬膜下血肿

Flush operation for elderly patients with chronic subdural hematoma by neuroendoscopy through burrhole approach

目的探讨一种新的治疗老年慢性硬膜下血肿(CSDH)的有效方法。方法对37例年龄介于60～86岁、平均68.5岁的CSDH患者采用软性神经纤维内镜下钻孔冲洗术进行治疗,其中5例为单纯采用钻孔冲洗引流术后复发患者。术中在直视下彻底冲洗血肿,清除血肿腔内的血凝块,电凝出血灶,打通血肿分隔并将血肿腔与正常硬膜下腔打通。结果随访2～18个月,所有患者血肿均完全消失,34例患者术后临床症状改善,无严重并发症及死亡病例出现。结论采用软性纤维神经内镜下的血肿钻孔冲洗术治疗CSDH可以明显提高治疗效果、避免血肿复发及钻孔冲洗引流术所带来的并发症。

Objective To discuss a new effective method for treatment of chronic subdural hematoma in elderly patients. Methods Flush operation for elderly patients with chronic subdural hematoma(CSDH) by neuroendoscopy through burrhole approach were performed in 37 elderly patients. The mean age of the group was 68.5 years (60-86 years). 5 cases were recurrent after simple drainage. Thoroughly flushs the hematoma cavity under television monitor, removes the clot, coagulates the bleeding focus, break the septum of hematoma cavity to make it communicate with the normal subdural space. Results On following up 2-18 months, all the hematoma disappeared, 34 cases improved in clinic manifestation, no serious complications and death occurred. Conclusions Flush operation for elderly patients with chronic subdural hematoma by flexible neuroendoscopy through burrhole approach can improve the therapeutic effect and avoid the recurrence and the complilcations of the traditional drainage therapy.