聚乙烯醇颗粒栓塞脑膜中动脉治疗慢性硬膜下血肿的临床价值初探

目的初步探讨聚乙烯醇颗粒栓塞脑膜中动脉治疗慢性硬膜下血肿的疗效、安全性及手术经验。方法选择陆军军医大学第一附属医院神经外科自2021年5月至2022年8月收治的51例慢性硬膜下血肿患者(初次治疗25例、阿托伐他汀治疗无效19例、钻孔引流术后复发7例)为研究对象。患者术前行三维时间飞越法(3D TOF) MRA评估脑膜中动脉特征, 无手术禁忌后于局麻下行单侧或双侧聚乙烯醇颗粒栓塞脑膜中动脉治疗。以术后血肿复发率及术后2个月血肿最大厚度减少>50%的患者比例为主要指标评估疗效, 并观察并发症及手术相关不良事件发生情况, 回顾性总结手术经验。结果 51例患者术前3D TOF MRA所示的脑膜中动脉特征均与术中造影所示一致, 其中16例单侧血肿患者术前3D TOF MRA示双侧脑膜中动脉增粗, 经术中造影证实为双侧供血后行双侧脑膜中动脉栓塞。51例患者均顺利完成手术, 其中单侧栓塞19例、双侧栓塞32例, 总栓塞脑膜中动脉83侧。48例患者治疗后血肿吸收、症状改善, 3例(5.9%)患者术后血肿复发, 治疗成功率为94.1%。除复发患者外, 共有39例患者完成术后2个月的随访, 其中血肿...     

慢性硬膜下血肿诊治进展

慢性硬膜下血肿（chronic subdural hematoma, CSDH）是中老年人常见的中枢神经系统疾病之一,发病率逐年升高。钻孔引流手术是公认的治疗慢性硬膜下血肿的有效方式之一,但术后仍存在不可忽视的复发率,同时伴随着人口老年化,基础疾病多,手术风险大,部分患者甚至由于长期服用抗凝或抗血小板药物,存在手术禁忌。近年来,在慢性硬膜下血肿的诊治方面取得了一些进展,比如口服阿托伐他汀可促进慢性硬膜下血肿吸收、小剂量地塞米松用于治疗慢性硬膜下血肿、神经内镜辅助治疗分隔型慢性硬膜下血肿以及脑膜中动脉栓塞手术降低慢性硬膜下血肿患者复发率。同时,随着影像学技术的发展,CT及MRI在诊断慢性硬膜下血肿方面也取得了一些进展。     

脑膜中动脉栓塞治疗合并血液恶性肿瘤的慢性硬膜下血肿2例

报道2例合并血液恶性肿瘤的慢性硬膜下血肿患者，经脑膜中动脉栓塞治疗，取得较良好的临床疗效，回顾其诊治过程并复习相关文献资料，分析病例特点及处理方式，以期为该类型患者诊治提供参考。 [国际神经病学神经外科学杂志, 2023, 50(2): 53-55]     

手术切除创伤性脑膜中动脉假性动脉瘤一例并文献复习

创伤性假性动脉瘤(traumatic pseudoaneurysm,TPA)占颅内动脉瘤的比例不到1%[1].创伤性脑膜中动脉假性动脉瘤更是少见,脑膜中动脉TPA破裂导致的硬膜下及脑内血肿则极为罕见.近期我们成功治疗1例创伤性脑膜中动脉假性动脉瘤迟发破裂导致的脑内血肿患者,一期完成了脑内血肿清除及脑膜中动脉假性动脉瘤切除手术,报告如下.     

手术切除创伤性脑膜中动脉假性动脉瘤一例并文献复习

创伤性假性动脉瘤(traumatic pseudoaneurysm,TPA)占颅内动脉瘤的比例不到1%[1].创伤性脑膜中动脉假性动脉瘤更是少见,脑膜中动脉TPA破裂导致的硬膜下及脑内血肿则极为罕见.近期我们成功治疗1例创伤性脑膜中动脉假性动脉瘤迟发破裂导致的脑内血肿患者,一期完成了脑内血肿清除及脑膜中动脉假性动脉瘤切除手术,报告如下.     

手术切除创伤性脑膜中动脉假性动脉瘤一例并文献复习

创伤性假性动脉瘤(traumatic pseudoaneurysm,TPA)占颅内动脉瘤的比例不到1%[1].创伤性脑膜中动脉假性动脉瘤更是少见,脑膜中动脉TPA破裂导致的硬膜下及脑内血肿则极为罕见.近期我们成功治疗1例创伤性脑膜中动脉假性动脉瘤迟发破裂导致的脑内血肿患者,一期完成了脑内血肿清除及脑膜中动脉假性动脉瘤切除手术,报告如下.     

硬膜AVM和脑膜瘤的雌激素栓塞疗法

硬膜AVM的治疗方法很多,包括手术切除、供血动脉结扎和栓塞等,但多不彻底,术后易于复发.作者从慢性硬膜下血肿的病因学与雌激素关系的动物实验研究中得到启示:既然大剂量雌激素可引起硬膜血循环紊乱,能否将之用于硬膜AVM的治疗呢?基于这一设想,氏等试用于8例海绵窦区和/或后颅窝AVM病人,收到了良好的效果,在另外3例脑膜瘤病人也达到了大大减少术中出血的目的.方法:局麻下,将一Teflon管(外径1.0mm,内径0.5mm)插入颈外动脉,直至畸形主要供血动脉起点处或供血动脉内.导管尾端与灌注泵相连,经泵注入Premarin(唯一可     

慢性硬膜下血肿（附122例分析）

慢性硬膜下血肿在临床上较为常见,治疗方法也较为简单。但目前治疗方法也多样,效果不定,缺乏循证后的科学治疗方法。本文通过对华山医院自1995年1月—2002年12月诊治的慢性硬膜下血肿的病例总结分析后,旨在结合文献归纳出治疗慢性硬膜下血肿(CSDH)的最佳方法。     

脑膜中动脉栓塞术治疗急性创伤性硬膜外血肿3例并文献复习

目的 探索通过脑膜中动脉(MMA)栓塞的方法治疗急性创伤性硬膜外血肿(ATEDH)的可行性及有效性。方法 回顾性分析南京医科大学附属逸夫医院神经外科2021年11月—2022年2月收治的3例MMA栓塞治疗ATEDH的临床资料,结合相关文献,探讨介入栓塞治疗硬膜外血肿的方法及疗效。结果 对于急性硬膜外血肿的患者,超早期进行介入栓塞治疗可以有效止血,消除血肿进展风险。结论 选择性MMA栓塞术超早期治疗ATEDH具有较高的安全性,可以有效避免患者接受创伤更大的外科手术治疗,降低患者花费,使患者获得更大的收益。     

钙化慢性硬膜下血肿的手术治疗

目的 探讨钙化慢性硬膜下血肿的治疗方法.方法 回顾性分析16例包膜钙化慢性硬膜下血肿的临床资料,并复习文献.结果 16例均行开颅清除血肿,并完整切除包膜,术后症状均缓解,1例巨大血肿患者术后有一过性失语,1月后恢复.结论 开颅手术清除血肿及其包膜是治疗钙化慢性硬膜下血肿的有效方法.     

Safety of Antithrombotic Resumption in Chronic Subdural Hematoma Patients with Middle Meningeal Artery Embolization: A Case Control Study

ObjectiveChronic subdural hematoma (CSDH) is a serious problem with an incidence of 20.6/100,000/year in North America and is posited to grow as the population ages. Middle Meningeal Artery (MMA) embolization is an upcoming therapy for treatment of CSDH. Among patients with CSDH who undergo MMA embolization outcomes are no different in patients who resume the antithrombotic (AT) after MMA embolization as compared to patients who don't resume AT.MethodsWe did retrospective review of all cases of MMA embolization in the setting of CSDH done over 2.5 years in 2 centers. Comparison of cases in which AT was resumed vs controls with no AT was performed. A successful outcome was defined as reduction of at least 50% volume in CSDH. Univariate analysis regarding all outcome measures for baseline variables was performed using Fisher exact test or t-test. Multivariate logistic regression with controlling for age, surgical evacuation of the hematoma.ResultsThere were a total of 56 MMA embolization cases, 33 of them had no AT started and 23 of them had AT resumption at a mean of 2.4 days. About 40% of patients had surgical evacuation done prior to MMA embolization. There was no significant difference in hematoma reduction or volume even after adjusting for surgical evacuation (OR 1.00 95%CI 0.60- 1.67). Patients who had AT resumption had more CAD (71%vs 21% p= 0.001) and Afib (58% vs 18% p=0.002) necessitating AT.ConclusionAT therapy can be safely resumed in CSDH after MMA embolization as there is no significant difference in CSDH volume reduction and recurrence.     

神经内窥镜辅助手术治疗慢性硬膜下血肿

目的探讨内窥镜技术在慢性硬膜下血肿(CSDH)手术治疗中的价值。方法 2008年1月~2012年12月,87例CSDH病人随机分为两组;内窥镜下冲洗引流组(n=42)和传统钻孔冲洗引流组(n=45),比较两组手术效果及术后并发症发生率。结果两组病例手术总有效率无显著差异,但两组恢复至Bender 0级的比率分别为80.0%和95.2%(P0.05)。传统手术组血肿复发9例(20.0%),内窥镜组血肿复发2例(5%),两组间术后血肿复发率有显著差异(P0.05)。结论内窥镜下手术治疗CSDH,效果好,降低了术后血肿复发率。     

一种新型封闭式钻孔引流术治疗慢性硬膜下血肿的临床疗效初步观察

目的观察慢性硬膜下血肿（CSDH）患者行单骨孔封闭冲洗及骨膜下引流术的疗效。 方法选取江阴市人民医院神经外科自2017年1月至2019年6月收治的CSDH患者106例，分为常规单骨孔钻孔引流术组（常规组）和单骨孔封闭冲洗及骨膜下引流术组（封闭组），对2组患者的手术疗效及并发症进行统计分析。 结果2组患者的手术疗效比较差异无统计学意义（Z=0.262，P>0.05）；封闭组术后颅内积气量明显低于常规组，差异有统计学意义（Z=3.963，P<0.05）；2组患者术后症状性气颅、脑损伤、切口脑脊液漏、癫痫发作、血肿复发的发生率比较差异无统计学意义（P>0.05）。 结论单骨孔封闭冲洗及骨膜下引流术治疗CSDH能明显降低术后颅内积气，是一种简单、有效、安全的治疗手段。     

慢性硬膜下血肿复发的影像学因素分析

目的通过影像学检查评估慢性硬膜下血肿（CSDH）复发的危险因素。 方法收集2014年1月至2018年12月在南通大学第二附属医院神经外科接受CSDH手术治疗的113例患者的临床资料。所有患者均接受钻孔外引流手术治疗,术后随访时间超过3个月,比较复发组与未复发组患者的临床资料,采用多因素Logistic回归分析CSDH患者复发的危险因素。 结果113例患者中,术后复发患者10例,未复发患者103例,术后复发率8.8%。复发组患者与非复发组患者在性别、年龄、术前血肿厚度、中线偏移比较差异均无统计学意义（P>0.05）,复发组与未复发组患者的血肿类型、血肿侧别比较,差异均具有统计学意义（P<0.05）。将单因素分析中有统计学意义的变量纳入Logistic回归分析,结果显示术前分隔分层和双侧血肿是CSDH复发的独立危险因素。 结论影像学术前血肿分隔分层型和双侧血肿是CSDH复发的危险因素。     

微创穿刺术和钻孔引流术治疗慢性硬膜下血肿的对比研究

目的 比较微创穿刺术(MPO)与钻孔引流术(TDO)治疗慢性硬膜下血肿(CSDH)的疗效.方法 本院收治64例慢性硬膜下血肿患者随机分为微创组30例,钻孔组34例,对两组患者术后并发症、术后3d及7d血肿清除率和术后1月复发率进行比较,并进行统计学分析.结果 微创穿刺术后气颅的发生率低于钻孔引流术,分别为6.6％和29.4％,差异有统计学意义(P＜0.05),两组术后新鲜出血、颅内感染、深部脑组织损伤、术后3d及术后7d血肿清除率和术后1月复发率两者比较无明显差别(P＞0.05).结论 微创穿刺术治疗慢性硬膜下血肿优于钻孔引流术,具有术后气颅发生率低、创伤轻微等优点.     

钻孔引流术与神经内窥镜治疗慢性硬膜下血肿的对照研究

目的对常规钻孔引流术与神经内窥镜手术治疗慢性硬膜下血肿的临床疗效进行对比,探讨ICAM-1、VCAM-1的表达和意义。方法选择常规钻孔引流术治疗64例患者为常规组,选择神经内镜下手术治疗56例患者为内镜组,评价2组临床疗效、并发症发生率及复发率,用ELISA法检测2组外周静脉血、脑膜血和血肿腔血中ICAM-1及VCAM-1的水平。结果常规组总有效率低于内镜组(P0.05);内镜组并发症总发生率为53.57%,低于常规组并发症总发生率(P0.05);常规组复发率高于内镜组(P0.05),2组外周静脉血、硬脑膜血清中ICAM-1及VCAM-1的表达水平均低于血肿腔血(P0.05),且2组外周静脉血与硬脑膜血清中ICAM-1及VCAM-1的表达水平无显著差异(P0.05)。结论神经内镜下手术治疗CSDH较常规钻孔引流术可以更好改善临床疗效,减少并发症,降低复发率,值得临床广泛推广,此外,ICAM-1及VCAM-1可能与CSDH的发病密切相关,对研究CSDH的发病机制具有重要的意义。     

慢性硬膜下血肿MRI表现和不同手术方法与其复发的关系

目的 探讨慢性硬膜下血肿(CSDH)术前MRI表现和不同手术方法与其复发的关系。方法 回顾分析了126例(共149个血肿)CSDH术前MRI资料,依血肿在MRI T_1 WI的表现分为高信号组(62例)和非高信号组(64例);又依治疗方法的不同,分为单纯钻孔冲洗治疗组和钻孔冲洗 闭式引流治疗组,分别比较其复发率。结果 高信号组和非高信号组复发率分别为4％和17.6％,两者相较,相差显著(P<0.05);钻孔引流和单纯钻孔复发率分别为6.1％和16.4％,两者相较,亦相差显著(P<0.05)。结论 CSDH术前MRI表现可以预测其复发率,采用闭式引流可以明显地减少其复发率。     

Efficacy of endoscopic treatment for chronic subdural hematoma surgery

Endoscopic treatment is a potential therapeutic addition to chronic subdural hematoma (CSDH) surgery. However, the effect of endoscopic treatment remains controversial. Herein, we examined the optimal indication for endoscopic treatment in CSDH surgery. We retrospectively analyzed 380 consecutive patients with CSDH who underwent single burr-hole craniostomy. We defined postoperative rebleeding as radiological re-accumulation or increased computed tomography value of the hematoma. Reoperation was performed following further hematoma accumulation and/or neurological deterioration. Complicated CSDH was radiologically defined as a hematoma with a clot and/or fibrous septum. There were no differences in baseline characteristics or postoperative mortality and morbidity between the endoscope (97 patients) and control (283 patients) groups. The incidence of postoperative rebleeding (9.3% vs 25.1%, respectively; P = 0.001) and reoperation (0% vs 9.2%, respectively; P = 0.004) were significantly lower in the endoscope group versus controls. Multivariate analysis showed that males (odds ratio 2.14, 95% confidence interval 1.19–3.81; P = 0.012) and endoscopy (odds ratio 0.29, 95% confidence interval 0.13–0.59; P = 0.001) were independently associated with postoperative rebleeding. When CSDHs were divided into two types based on hematoma component, 175 patients exhibited complicated CSDH. There was a significant reduction in postoperative rebleeding (6.5% vs 23.0%, respectively; P = 0.010) and reoperation (0% vs 9.7%, respectively; P = 0.027) in complicated CSDH patients. Endoscopic treatment in CSDH surgery does not increase the risk of surgical complications. Complicated CSDH with a clot and/or septum may be an optimal indication for endoscopic treatment in CSDH surgery to reduce postoperative recurrence.     

应用Subdural专用引流管治疗慢性硬膜下血肿

目的比较钻孔闭式引流和Subdural专用引流管穿刺引流在慢性硬膜下血肿(CSDH)中的疗效。方法回顾分析我院收治的88例CSDH患者,46例行钻孔闭式引流(A组),42例行Subdural专用引流管穿刺引流术(B组),比较两组治疗效果。结果A组40例一次钻孔引流成功,6例因继发颅内血肿而改行开颅手术,再手术率13.04%,癫发作3例;B组41例一次性引流成功,1例因继发血肿再次手术,再手术率2.38%,无癫发作。结论Subdural引流术较钻孔冲洗闭式引流术更微创、更安全有效,并发症少,宜作为治疗CSDH的首选方法。     

Anticoagulation therapy a risk factor for the development of chronic subdural hematoma

Objective

Chronic subdural hematoma (CSDH) is a common disease among the elderly and with increasing incidence we have chosen to focus on associations between development and recurrence of CSDH and anticoagulation and/or antiplatelet agent therapy.

Methods

We conducted a retrospective review of 239 patients undergoing surgery for CSDH over a period of six years (2006–2011). Risk factors such as age, head trauma, anticoagulant and/or antiplatelet agent therapy and co-morbidity were investigated along with gender, coagulation status, laterality, surgical method and recurrence.

Results

Seventy-two percent of the patients were male and the mean age was 71.8 years (range 28–97 years). Previous fall with head trauma was reported in 60% of the patients while 16% were certain of no previous head trauma. The majority of patients (63%) in the non-trauma group were receiving anticoagulants and/or antiplatelet agent therapy prior to CSDH presentation, compared to 42% in the trauma group. Twenty-four percent experienced recurrence of the CSDH. There was no association between recurrence and anticoagulant and/or antiplatelet agent therapy.

Conclusion

Anticoagulant and/or antiplatelet aggregation agent therapy is more prevalent among non-traumatic CSDH patients but does not seem to influence the rate of CSDH recurrence.