慢性硬膜下血肿的微钻开颅术和围手术期治疗：单中心经验

IF 0.4 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management Pub Date : 2025-03-01 DOI:10.1016/j.inat.2025.102001

Tao Wu, Xu Chen, Yueping Wang, Xianghua Zhang, Jing Zhang, Jianjun Sun, Cang Liu

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引用次数: 0

摘要

背景与目的目前研究的重点是慢性硬膜下血肿（CSDH）的手术安全性和术后复发治疗。本研究提出微钻开颅引流术结合围手术期治疗。目的是描述和验证这种治疗方法，并探讨影响复发的危险因素，以进一步改善CSDH的治疗效果。方法回顾性分析2018 - 2023年接受CSDH手术的患者。根据复发情况将患者分为两组，进行多元logistic回归分析，找出术后复发的独立因素。并详细介绍了微钻开颅引流术的手术技术及围手术期的治疗方案。结果106例140例CSDH均行手术治疗。所有患者的临床症状均有不同程度的改善。无围手术期死亡或手术并发症发生。复发12例（8.6%），其中9例经保守治疗。其余3例均行相同手术方式及尿激酶注射治疗，末次随访均无复发。对所有临床变量进行单因素分析，尿激酶注射组的复发率明显低于对照组（P = 0.001），引流时间较对照组（P = 0.042）。多元logistic回归分析发现，在调整年龄、抗凝治疗、CT密度、最大厚度、肺炎等危险因素后，术后未注射尿激酶是复发的独立危险因素（优势比：0.011,95%可信区间：0 ~ 0.485,P = 0.018）。结论微钻开颅引流联合围手术期阿托伐他汀治疗CSDH安全有效。建议将尿激酶注射液作为CSDH的常规治疗，需要进一步的前瞻性随机对照试验来验证其使用细节和疗效。

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Micro-drill craniostomy and perioperative treatment for chronic subdural hematoma: A single-center experience

Background and Objectives

The current research focuses on surgical safety and postoperative recurrence of chronic subdural hematoma (CSDH) treatment. This study proposes a micro-drill craniostomy drainage combined with perioperative treatment. The aim is to describe and validate this treatment approach and explore the risk factors influencing recurrence, to further improve the treatment outcomes for CSDH.

Methods

A retrospective analysis was conducted on patients who underwent surgery for CSDH from 2018 to 2023. These patients were divided into two groups based on recurrence, and multiple logistic regression analyses were performed to identify the independent factors of postoperative recurrence. Additionally, detailed descriptions of the micro-drill craniostomy drainage surgical technique and perioperative treatment plan were provided.

Results

A total of 106 patients with 140 CSDH were treated surgically. All patients experienced varying degrees of improvement in their clinical symptoms. No perioperative deaths or surgical complications occurred. Twelve recurrence cases were observed (8.6 %), 9 of which were managed through conservative treatment. The remaining three cases were treated with the same surgical procedure and urokinase injection, and no recurrence was observed during the last follow-up. After univariate analyses of all the clinical variables, the rate of recurrence was significantly lower in urokinase injection (P = 0.001) and long drainage duration (P = 0.042). Multiple logistic regression analysis identified the absence of postoperative urokinase injection was an independent risk factor for recurrence (odds ratio: 0.011, 95 % confidence interval: 0 – 0.485, P = 0.018), after adjustment for age, anticoagulant therapy, CT density, maximal thickness, pneumocrania, and other risk factors.

Conclusion

The combination of micro-drill craniostomy drainage and perioperative atorvastatin treatment is safe and effective for CSDH. It is recommended that urokinase injection as a routine treatment CSDH and further prospective randomized controlled trial is needed to validate its usage details and efficacy.

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