Optimizing shunt integrity during acute subdural hematoma evacuation.

Surgical neurology international Pub Date : 2024-09-27 eCollection Date: 2024-01-01 DOI:10.25259/SNI_411_2024
Tatsuya Tanaka, Hirofumi Goto, Nobuaki Momozaki, Eiichiro Honda, Eiichi Suehiro, Akira Matsuno
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Abstract

Background: Even mild head trauma can cause severe intracranial hemorrhage in patients with cerebrospinal fluid (CSF) shunts for hydrocephalus. CSF shunts are considered a risk factor for subdural hematoma (SDH). The management of acute SDH (ASDH) in shunted patients with normal pressure hydrocephalus can be challenging. Addressing the hematoma and the draining function of the shunt is important. To preserve the shunt, we set the shunt valve pressure to the highest and perform hematoma evacuation for ASDH. In this study, we report the surgical cases of ASDH in patients with shunts.

Methods: Between 2013 and 2019, five patients with ASDH and CSF shunts underwent hematoma evacuation at our hospital. We retrospectively analyzed data regarding their clinical and radiological presentation, hospitalization course, the use of antithrombotic medications, and response to different treatment regimens.

Results: The patients presented with scores of 5-14 in the Glasgow coma scale and severe neurological signs, consciousness disturbance, and hemiparesis. Most patients were elderly, taking antithrombotic medications (four of five cases), and had experienced falls (4 of 5 cases). All patients underwent hematoma evacuation following resetting their programmable shunt valves to their maximal pressure setting and shunt preservation. ASDH enlargement was observed in only one patient who underwent burr-hole drainage. Glasgow outcome scale scores at discharge were 1 and 3, respectively.

Conclusion: In hematoma evacuation, increasing the valve pressure may reduce the bleeding recurrence. To preserve the shunt, setting the shunt valve pressure to the highest level and performing endoscopic hematoma evacuation with a small craniotomy could be useful.

优化急性硬膜下血肿清除过程中分流管的完整性。
背景:因脑积水而进行脑脊液(CSF)分流的患者,即使是轻微的头部外伤也可能导致严重的颅内出血。脑脊液分流术被认为是硬膜下血肿(SDH)的危险因素。对分流后的正常压力脑积水患者进行急性 SDH(ASDH)治疗具有挑战性。处理血肿和分流管的引流功能非常重要。为了保留分流管,我们将分流阀压力调到最高,并对 ASDH 进行血肿排空。在本研究中,我们报告了分流患者 ASDH 的手术病例:方法:2013 年至 2019 年期间,5 例 ASDH 和 CSF 分流患者在我院接受了血肿抽吸术。我们回顾性分析了他们的临床和影像学表现、住院过程、抗血栓药物的使用以及对不同治疗方案的反应:结果:患者的格拉斯哥昏迷量表评分为 5-14 分,并伴有严重的神经体征、意识障碍和偏瘫。大多数患者为老年人,正在服用抗血栓药物(5 例中的 4 例),并有跌倒经历(5 例中的 4 例)。所有患者都在将可编程分流阀重新设置为最大压力并保留分流后进行了血肿清除。只有一名接受了毛细孔引流术的患者出现了 ASDH 扩大。出院时格拉斯哥结果量表评分分别为1分和3分:结论:在血肿清除过程中,增加瓣膜压力可减少出血复发。为了保留分流管,将分流管瓣膜压力调至最高,并通过小范围开颅手术进行内镜下血肿清除可能会有所帮助。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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