改良锥颅置管引流术治疗慢性硬膜下血肿

Modified twist-drill craniotomy and drainage method for treatment of chronic subdural hematoma

目的评价改良锥颅置管引流法治疗慢性硬膜下血肿（CSDH）的效果。方法选择本院收治的CSDH患者56例，采用局麻锥颅改良置管法治疗，将常用脑室外引流管内导丝末端进行弯曲处理，锥颅，再将引流管置入骨孔后沿弯曲处理过的导丝紧贴硬脑膜内面送入血肿腔，拔除导丝后密闭引流。记录手术持续时间，于术后24、48和72h行头颅CT检查，计算血肿清除率，观察并发症发生情况。结果所有患者均一次性置管成功，手术持续约30min。术后24h复查头颅CT显示56例（100％）引流管位置均良好，血肿量明显减少，无颅内积气，无脑组织损伤；术后48h复查头颅CT显示47例（83．9％）血肿基本消失，遂拔除引流管；术后72h复查头颅CT9例（16．1％）血肿虽仍有少量残留，但也能拔除引流管。所有患者均未出现感染，无脑组织损伤、癫痫发作等并发症，1周内出院。结论改良锥颅置管引流法治疗CSDH可有效避免脑损伤，且安全、有效。

Objective To evaluate the effect of modified twist-drill craniotomy and drainage method for treatment of chronic subdural hematoma （CSDH） . Methods Fifty-six patients of CSDH were treated by modified twist- drill craniotomy under local anaesthesia. The distal end of the guide-wire inside the catheter which was commonly used in external ventricular drainage was bended, then conventional twist-drill craniotomy was performed, after the insertion of drainage catheter into the bone hole, along the course of the bended end of guide-wire which was closely adherent to the inner surface of dura to advance forward, the catheter was sent into the hematoma cavity, at last, the guide-wire was removed and drainage sealed closely. The operation time was recorded. After 24, 48 and 72 hours, all cases were examined by CT scan respectively. Hematoma clearance rate was calculated. Complications were investigated. Results All cases＇ catheters were successfully put into hematomas with only once of placement, and the operation lasted for about 30 minutes. Twenty-four hours later, the CT scans of 56 cases （100%） revealed that the location of drainage catheter was good and hematoma volume was significantly reduced without intracranial pneumatosis and brain injury. Forty-eight hours later, the CT scans of 47 cases （83.9%） showed that hematoma basically disappeared, and the drainage tube was extracted ; 72 hours later, the CT scans of 9 cases （16.1%） demonstrated that there were a few amount of residues in the hematomas and the drainage tube also could be extracted. All patients were discharged in one week without infection, brain injury and seizures. Conclusion The modified twist-drill craniotomy and drainage method for treatment of CSDH can prevent brain injury and has no adverse reactions, thus the procedure is safe and effective.