Background: Chronic subdural hematoma (CSDH) is a common complication in head injuries. The objective of this study is to establish the evolution of traumatic subdural effusion (TSDE) into CSDH using clinical signs an...Background: Chronic subdural hematoma (CSDH) is a common complication in head injuries. The objective of this study is to establish the evolution of traumatic subdural effusion (TSDE) into CSDH using clinical signs and symptoms as well as radiology. Our aim is to effectively manage such cases without postoperative recurrence (PR). Methodology: The study was a retrospective cohort carried out in the No. 1 People’s Hospital of Jingzhou from August 2007 to November 2013. The hospital is affiliated to the Yangtze University. All the patients included in this study were involved in road traffic accidents and sustained various degree of head injury. Serial CT scans were done to establish the development TSDE and the evolution of the TSDE into CSDH and treatment options. Results: In all 159 patients developed TSDE and out of these 34 which constitute 21.38% had their TSDE evolving into CSDH. Most of the patients were elderly. Twelve patients were treated conservatively while the remaining patients were treated surgically by drilling and drainage of hematoma. All the patients survived with marked improvement in their sign and symptoms with no recurrence. Conclusion: TSDE is one of the etiological factors for the development of CSDH in the elderly although in most cases the etiology of CSDH is usual multifactory. It must be stated clearly that, the evolution of TSDE into CSDH is initially a hidden process and presents with nonspecific signs and symptoms which can easily be missed. CT scan is usually the initial radiology of choice in making diagnosis of TSDE but MRI could be used to make early diagnosis of the transgression of TSDE into CSDH, and hence early surgical intervention before the formation of a neomembrane could reduce PR rate.展开更多
Introduction: Chronic subdural hematoma (CSDH) is one of the most common types of intracranial hemorrhages and carries a significant morbidity;there is no clear optimal treatment. Recurrence, pneumocephaly and seizure...Introduction: Chronic subdural hematoma (CSDH) is one of the most common types of intracranial hemorrhages and carries a significant morbidity;there is no clear optimal treatment. Recurrence, pneumocephaly and seizures are common complications. We will evaluate outcome after inner membrane fenestration in comparison to burr-hole evacuation only in cases of CSDH. Patients and Methods: Our work was conducted on 20 patients with CSDH from February 2017 to July 2017. Endoscopic-assisted microscopic fenestration technique was used to do inner membrane fenestration in ten patients and the other 10 patients operated upon by traditional burr-hole evacuation. Regular follow up was done up to one month. Results: Clinical outcome was nearly the same in the two groups. Recurrence rate was only noted in the non-fenestration group (20%). Midline shift was better in the membrane fenestration group after one month and we experienced no intraoperative surgical complications related to the fenestration technique. Postoperative complications, such as Pneumocephalus and seizures, were seen in both study groups. Conclusion: Endoscopic assisted microscopic technique decreases surgical risks to do inner membrane fenestration although there is no major difference between doing fenestration or not in clinical outcome, but it may decrease recurrence, but larger studies are needed.展开更多
目的 探讨神经内镜内技术（INET）在治疗亚急性-慢性和慢性分隔硬膜下血肿中的安全性、有效性和临床应用价值。方法 采用非随机同期对照的研究方法将2015-05～2018-04符合纳入标准的74例患者分成INET治疗组（INET组）35例和钻孔引流治...目的 探讨神经内镜内技术（INET）在治疗亚急性-慢性和慢性分隔硬膜下血肿中的安全性、有效性和临床应用价值。方法 采用非随机同期对照的研究方法将2015-05～2018-04符合纳入标准的74例患者分成INET治疗组（INET组）35例和钻孔引流治疗组（对照组）39例。记录并比较两组间的手术时间、硬膜下引流管（SDT）放置时间、颅内感染率及术后随访1个月时的Bender分级和6个月的血肿复发率。建立多参数Logistic回归模型，分析6个月内与复发相关的危险因素。结果 INET组手术时间长于对照组［（64.4±13.6）min vs. （44.1±10.8）min，P=0.00］，但其术后随访6个月内的血肿复发率（2.9% vs. 23.0%，P=0.04）和SDT放置时间均低于对照组［（2.1±0.7）d vs. （3.9±0.8）d,P=0.00］；颅内感染率在两组间比较差异无统计学意义（0.0 vs. 5.1%，P=0.52）。随访1个月时的Bender分级总体有效率（100% vs. 89.7%，P=0.15）两组间比较差异无统计学意义，但恢复至Bender 0级无症状患者的比率INET组高于对照组（94.2% vs. 76.9%，P=0.04）。多参数Logistic回归分析显示，应用INET手术（OR 3.62, 95%CI1.202～10.911, P=0.02）、年龄在65岁及以下（OR1.65, 95%CI1.051～2.602, P=0.03）和单侧硬膜下血肿（OR1.61, 95%CI 1.067～2.418, P=0.02）是术后复发率降低的独立影响因素。结论 INET能够降低亚急性-慢性和慢性分隔硬膜下血肿的术后复发率，改善临床预后，是治疗该类疾病的一种安全、有效的新手术方法。展开更多
文摘Background: Chronic subdural hematoma (CSDH) is a common complication in head injuries. The objective of this study is to establish the evolution of traumatic subdural effusion (TSDE) into CSDH using clinical signs and symptoms as well as radiology. Our aim is to effectively manage such cases without postoperative recurrence (PR). Methodology: The study was a retrospective cohort carried out in the No. 1 People’s Hospital of Jingzhou from August 2007 to November 2013. The hospital is affiliated to the Yangtze University. All the patients included in this study were involved in road traffic accidents and sustained various degree of head injury. Serial CT scans were done to establish the development TSDE and the evolution of the TSDE into CSDH and treatment options. Results: In all 159 patients developed TSDE and out of these 34 which constitute 21.38% had their TSDE evolving into CSDH. Most of the patients were elderly. Twelve patients were treated conservatively while the remaining patients were treated surgically by drilling and drainage of hematoma. All the patients survived with marked improvement in their sign and symptoms with no recurrence. Conclusion: TSDE is one of the etiological factors for the development of CSDH in the elderly although in most cases the etiology of CSDH is usual multifactory. It must be stated clearly that, the evolution of TSDE into CSDH is initially a hidden process and presents with nonspecific signs and symptoms which can easily be missed. CT scan is usually the initial radiology of choice in making diagnosis of TSDE but MRI could be used to make early diagnosis of the transgression of TSDE into CSDH, and hence early surgical intervention before the formation of a neomembrane could reduce PR rate.
文摘Introduction: Chronic subdural hematoma (CSDH) is one of the most common types of intracranial hemorrhages and carries a significant morbidity;there is no clear optimal treatment. Recurrence, pneumocephaly and seizures are common complications. We will evaluate outcome after inner membrane fenestration in comparison to burr-hole evacuation only in cases of CSDH. Patients and Methods: Our work was conducted on 20 patients with CSDH from February 2017 to July 2017. Endoscopic-assisted microscopic fenestration technique was used to do inner membrane fenestration in ten patients and the other 10 patients operated upon by traditional burr-hole evacuation. Regular follow up was done up to one month. Results: Clinical outcome was nearly the same in the two groups. Recurrence rate was only noted in the non-fenestration group (20%). Midline shift was better in the membrane fenestration group after one month and we experienced no intraoperative surgical complications related to the fenestration technique. Postoperative complications, such as Pneumocephalus and seizures, were seen in both study groups. Conclusion: Endoscopic assisted microscopic technique decreases surgical risks to do inner membrane fenestration although there is no major difference between doing fenestration or not in clinical outcome, but it may decrease recurrence, but larger studies are needed.
文摘目的 探讨神经内镜内技术（INET）在治疗亚急性-慢性和慢性分隔硬膜下血肿中的安全性、有效性和临床应用价值。方法 采用非随机同期对照的研究方法将2015-05～2018-04符合纳入标准的74例患者分成INET治疗组（INET组）35例和钻孔引流治疗组（对照组）39例。记录并比较两组间的手术时间、硬膜下引流管（SDT）放置时间、颅内感染率及术后随访1个月时的Bender分级和6个月的血肿复发率。建立多参数Logistic回归模型，分析6个月内与复发相关的危险因素。结果 INET组手术时间长于对照组［（64.4±13.6）min vs. （44.1±10.8）min，P=0.00］，但其术后随访6个月内的血肿复发率（2.9% vs. 23.0%，P=0.04）和SDT放置时间均低于对照组［（2.1±0.7）d vs. （3.9±0.8）d,P=0.00］；颅内感染率在两组间比较差异无统计学意义（0.0 vs. 5.1%，P=0.52）。随访1个月时的Bender分级总体有效率（100% vs. 89.7%，P=0.15）两组间比较差异无统计学意义，但恢复至Bender 0级无症状患者的比率INET组高于对照组（94.2% vs. 76.9%，P=0.04）。多参数Logistic回归分析显示，应用INET手术（OR 3.62, 95%CI1.202～10.911, P=0.02）、年龄在65岁及以下（OR1.65, 95%CI1.051～2.602, P=0.03）和单侧硬膜下血肿（OR1.61, 95%CI 1.067～2.418, P=0.02）是术后复发率降低的独立影响因素。结论 INET能够降低亚急性-慢性和慢性分隔硬膜下血肿的术后复发率，改善临床预后，是治疗该类疾病的一种安全、有效的新手术方法。
