ON THE PHASING OF THE CLINICAL COURSE OF PERSISTENT SUBDURAL HYDROMAS AND ON THE SELECTIVE-BY-PHASE APPROACH TO THE CHOICE OF SURGICAL INTERVENTION

Abstract

The work is based on the analysis of the surgical treatment of 181 injured persons with traumatic subdural hydromas. The clynic and pathogenic peculiarities, as well as neurological symptoms of the subdural hydromas, without complications of satellite forms of traumatic brain injury, have been specified. For the first time has been noticed the quite common feature of subdural hydromas – clynic stages of development of subdural hydromas; neurological symptoms have been described, which is characteristic of the transformation of original, not complicated stage of subdural hydromas to complicated, persistent clynic stage. The usage of comparison of intra-surgical findings and clynic-neurological features enabled to identify of the correlation and dependence of pathanatomic states of the brain, caused by the damaging impact of the mass accumulation of liquid in a subdural hollow in case of persistent clynic forms of subdural hydromas. It has been specified that the persistent clynic form more often takes place in case of inertial injuries and in case of valve formation of hydromas. It is demonstrated that in the case of persistent clynic forms, limbic puncture and forced dehydration therapy are not appropriate, as they can worsen dislocation processes and the state of the injured. Based on the sufficient clynic material, it has been proven that in the complicated, persistent clynic stage, the only effective remedy is the extended brain-plastic kranitomiya, with introsurgic correction of the collated brain by means of the introduction of 10-15 milliliters of distilled solution or 20-25 cub. of air to lateral ventricles through their lower horn and thus creating in the end of supplementary, reserve space, by means of exfoliation around the trepan hole of skin-apponeurotic patch from the periosteum, in the depth of 10-15 sm, for “withdrawal” of cerebrospinal fluid, which is permanently entering subdural hollow, in order to avoid the formation of conditions for mass effect, compression and dislocation of the brain. Alongside the innovative surgical methods of treatment of the injured persons, it is recommended, with the aim of improvement in reanimation measures for brain flood supply and perfusion of the brain, the means which are upgrading left ventricles mass blood flood. In cases of complicated, persistent forms of subdural hydromas, it is highly advisable to apply repeated big surgery than prolonged conservative treatment and forced dehydration therapy.