Minimally invasive decompression of chronic subdural haematomas using hollow screws: efficacy and safety in a consecutive series of 320 cases

详细信息    查看全文

• 作者：Sandro M. Krieg (1)
  Fanny Aldinger (1)
  Michael Stoffel (1)
  Bernhard Meyer (1) (2)
  Juergen Kreutzer (1)
  
• 关键词：Chronic subdural haematoma ; Decompression ; Hollow screw ; Drainage
• 刊名：Acta Neurochirurgica
• 出版年：2012
• 出版时间：April 2012
• 年：2012
• 卷：154
• 期：4
• 页码：699-705
• 全文大小：231KB
• 参考文献：1. Aoki N (1984) Subdural tapping and irrigation for the treatment of chronic subdural hematoma in adults. Neurosurgery 14:545-48 CrossRef
  2. Bender MB, Christoff N (1974) Nonsurgical treatment of subdural hematomas. Arch Neurol 31:73-9 CrossRef
  3. Camel M, Grubb RL Jr (1986) Treatment of chronic subdural hematoma by twist-drill craniotomy with continuous catheter drainage. J Neurosurg 65:183-87 CrossRef
  4. Emonds N, Hassler WE (1999) New device to treat chronic subdural hematoma–hollow screw. Neurol Res 21:77-8
  5. Ernestus RI, Beldzinski P, Lanfermann H, Klug N (1997) Chronic subdural hematoma: surgical treatment and outcome in 104 patients. Surg Neurol 48:220-25 CrossRef
  6. Gilsbach J, Eggert HR, Harders A (1980) [External closed drainage treatment of chronic subdural hematomas after bore-hole trepanation]. Unfallchirurgie 6:183-86 CrossRef
  7. Ito H, Saito K, Yamamoto S, Hasegawa T (1988) Tissue-type plasminogen activator in the chronic subdural hematoma. Surg Neurol 30:175-79 CrossRef
  8. Ito H, Yamamoto S, Saito K, Ikeda K, Hisada K (1987) Quantitative estimation of hemorrhage in chronic subdural hematoma using the 51Cr erythrocyte labeling method. J Neurosurg 66:862-64 CrossRef
  9. Javadi A, Amirjamshidi A, Aran S, Hosseini SH (2011) A randomized controlled trial comparing the outcome of burr-hole irrigation with and without drainage in the treatment of chronic subdural hematoma: a preliminary report. World Neurosurg 75:731-36, discussion 620-733 CrossRef
  10. Kawakami Y, Chikama M, Tamiya T, Shimamura Y (1989) Coagulation and fibrinolysis in chronic subdural hematoma. Neurosurgery 25:25-9 CrossRef
  11. Kotwica Z, Brzezinski J (1991) Chronic subdural haematoma treated by burr holes and closed system drainage: personal experience in 131 patients. Br J Neurosurg 5:461-65 CrossRef
  12. Markwalder TM (1981) Chronic subdural hematomas: a review. J Neurosurg 54:637-45 CrossRef
  13. Markwalder TM, Steinsiepe KF, Rohner M, Reichenbach W, Markwalder H (1981) The course of chronic subdural hematomas after burr-hole craniostomy and closed-system drainage. J Neurosurg 55:390-96 CrossRef
  14. Okada Y, Akai T, Okamoto K, Iida T, Takata H, Iizuka H (2002) A comparative study of the treatment of chronic subdural hematoma—burr hole drainage versus burr hole irrigation. Surg Neurol 57:405-09, discussion 410 CrossRef
  15. Ram Z, Hadani M, Sahar A, Spiegelmann R (1993) Continuous irrigation-drainage of the subdural space for the treatment of chronic subdural haematoma. A prospective clinical trial. Acta Neurochir (Wien) 120:40-3 CrossRef
  16. Reinges MH, Hasselberg I, Rohde V, Kuker W, Gilsbach JM (2000) Prospective analysis of bedside percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults. J Neurol Neurosurg Psychiatry 69:40-7 CrossRef
  17. Rohde V, Graf G, Hassler W (2002) Complications of burr-hole craniostomy and closed-system drainage for chronic subdural hematomas: a retrospective analysis of 376 patients. Neurosurg Rev 25:89-4 CrossRef
  18. Sambasivan M (1997) An overview of chronic subdural hematoma: experience with 2300 cases. Surg Neurol 47:418-22 CrossRef
  19. Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, Richards HK, Marcus H, Parker RA, Price SJ, Kirollos RW, Pickard JD, Hutchinson PJ (2009) Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet 374:1067-073 CrossRef
  20. Smely C, Madlinger A, Scheremet R (1997) Chronic subdural haematoma--a comparison of two different treatment modalities. Acta Neurochir (Wien) 139:818-25 CrossRef
  21. Tabaddor K, Shulmon K (1977) Definitive treatment of chronic subdural hematoma by twist-drill craniostomy and closed-system drainage. J Neurosurg 46:220-26 CrossRef
  22. van Eck AT, de Langen CJ, Borm W (2002) Treatment of chronic subdural haematoma with percutaneous needle trephination and open system drainage with repeated saline rinsing. J Clin Neurosci 9:573-76 CrossRef
  
• 作者单位：Sandro M. Krieg (1)
  Fanny Aldinger (1)
  Michael Stoffel (1)
  Bernhard Meyer (1) (2)
  Juergen Kreutzer (1)
  
  1. Department of Neurosurgery, Technische Universit?t München, Munich, Germany
  2. Department of Neurosurgery, Klinikum rechts der Isar, Technische Universit?t München, Ismaninger Str. 22, 81675, Munich, Germany
  

文摘

Background Chronic subdural haematoma (cSDH) is a frequent pathology in neurosurgery. Surgical treatment varies widely and is often characterised by repeated decompression. Therapeutic efficacy was evaluated by clinical symptom relief and haematoma reduction on preoperative and postoperative CT scans. Methods We investigated a consecutive series of 320 cases of cSDH between 2006 and 2010. In this series, the first- and second-line treatments were performed via hollow-screw placement under local anaesthesia, whereas enlarged burr holes under general anaesthesia were used as third-line treatment. Results In general, 63.3% of cases were sufficiently treated by a single operation, while 16.2% needed a second procedure with hollow screws. Only 20.5% needed open surgery by an enlarged burr hole with membranectomy under general anaesthesia. After the first operation, initial symptoms improved in 80.3% of cases, remained unchanged in 15.5% and worsened in 4.2% of cases. Mean age was 74.6?±-2.1?years, with only one case of severe surgery-related complication. Conclusions Initial placement of hollow screws under local anaesthesia is a safe and sufficient treatment in most cases, and should be favoured as first-line treatment in patients with cSDH, since these patients are often of older age and present with distinct comorbidity.