显微血管减压术后幕上硬膜下血肿的临床特点和预后

Clinical characteristics and outcomes of supratentorial subdural hematoma following microvas-cular decompression

目的总结显微血管减压术(MVD)后幕上硬膜下血肿(SDH)的主要临床特点和预后。方法2015年1月至2017年9月中日友好医院神经外科行MVD的4 937例患者中,术后常规CT确诊为幕上SDH者29例(5.9‰)。其中行面肌痉挛(HFS)手术3 656例,21例(5.7‰)发生幕上SDH;三叉神经痛(TN)手术1 197例,8例(6.7‰)发生幕上SDH;舌咽神经痛(GN)手术84例,无一例发生幕上SDH。29例患者均先行保守治疗。回顾性分析29例幕上SDH患者的临床特点及预后。结果29例患者中,男/女=11/18;年龄为19~79岁,平均(53.0±15.3)岁;病程为0.5~20.0年,中位病程为5.0年;血肿位于手术侧同侧16例(55.2%),对侧10例(34.5%),双侧3例(10.3%)。出血量为2~15 ml,平均(6.5±3.6)ml。28例进行保守治疗,其中26例于出院时血肿已完全消失或大部分吸收,2例随访期吸收;1例出院时转为慢性SDH,行钻孔引流术后预后良好。术后6个月随访均无血肿相关并发症发生。27例(93.1%)患者对原疾病治疗有效。结论MVD术后幕上SDH的发生率极低,绝大部分患者保守治疗后预后良好。建议MVD术后常规行CT检查。

Objective To summarize the clinical features of supratentorial subdural hematoma (SDH) following microvascular decompression (MVD). Methods A retrospective review of 4 937 consecutive patients who underwent MVD at Department of Neurosurgery, China-Japan Friendship Hospital between January 2015 and September 2017 revealed 29 patients with postoperative supratentorial SDH accounting for 5.9‰ of all MVD cases. Among the 29 patients with supratentorial SDH, 21 cases(5.7‰) occurred out of 3 656 patients following MVD for HFS (hemifacial spasm), 8(6.7‰) out of 1 197 patients for TN (trigeminal neuralgia). In addition, there were 84 cases of GN (glossopharyngeal neuralgia) and none of them developed SDH.A retrospective review of clinical features and outcomes of 29 patients with supratentorial SDH. Results The 29 patients included 11 males and 18 females. Their age ranged from 19 to 79 years old, with an average of 53.0±15.3 years old. The duration of illness was 0.5-20.0 years, with the median of 5.0 years. In 29 patients, supratentorial SDH occurred ipsilaterally in 16(55.2%) cases, contralaterally in 10(34.5%)cases, and bilaterally in 3(10.3%)cases. Hemorrhagic amount by CT analysis ranged from 2 ml to 15 ml, with the average of 6.5±3.6 ml. Among 28 patients with conservative treatment, 26 displayed complete or obvious absorption of hematomas at discharge and 2 showed hematoma absorption during follow-up. One patient turned into chronic supratentorial SDH and achieved good outcome following single-bore drainage. There was no SDH-related symptoms developed during the 6-month follow-up. Treatment of original illness remained effective in 27 (93.1%) cases. Conclusions The incidence of supratentorial SDH after MVD is much lower than other complications of MVD. Furthermore, most patients with conservative treatment seem to have good outcome. Even though, postoperative CT scan is recommended for all MVD patients.