Risk factors for the occurrence of chronic subdural haematomas after neurosurgical procedures
Risk factors for the occurrence of chronic subdural haematomas after neurosurgical procedures
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DOI：
10.1007/s00701-003-0026-1
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发表时间：
2003-07-01
影响因子：
2.4
通讯作者：
Maeda, M
中科院分区：
文献类型：
--
作者：
Mori, K;Maeda, M
慢性硬膜下血肿是神经外科手术中一种罕见的并发症。CSDH在动脉瘤夹闭术和血运重建术后偶尔发生，但风险因素尚不清楚。本研究回顾了从1987年1月至2001年7月进行的6613例连续神经外科手术，并确定了621例CSDH。这621例病例中有50例有神经外科治疗的神经系统疾病既往史。本研究评估了这50例病例，以阐明神经外科术后CSDH的临床和放射学特征，并探讨CSDH作为术后并发症的危险因素的病因。神经外科术后慢性硬膜下血肿的发生率为0.8%（50/6613）。50例有神经外科既往史的患者中有27例接受了动脉瘤夹闭术。夹闭术后发生率为2.4%。这27例病例中有12例还接受了脑室腹膜分流术。3例患者在蛛网膜囊肿切开和/或分流术后发生CSDH。发病率最高，为7.5%。3例患者在脑肿瘤手术后发生术后CSDH。发病率较低，为0.4%。然而，在这3例患者中，有2例在肿瘤切除过程中开放了脑室脑脊液（CSF）空间，蛛网膜下腔与硬膜下腔的连通被认为是病因之一，过度的CSF分流有助于神经外科手术后CSDH的形成。在神经外科手术中修复蛛网膜撕裂和避免过度的CSF分流可以降低神经外科手术后CSDH的风险。
Chronic subdural haematoma (CSDH) is a rare clinical complication of neurosurgical procedures. CSDH occurs sporadically after aneurysm clipping surgery and revascularisation surgery but the risk factors are not known. The present study reviewed 6613 consecutive neurosurgical procedures performed from January 1987 to July 2001, and identified 621 cases of CSDH. Fifty of these 621 cases had a past history of neurological disorders treated by neurosurgery. This study evaluated these 50 cases in order to elucidate the clinical and radiological characteristics of CSDH after neurosurgery and to investigate the etiology for identifying in the risk factors of CSDH as a postoperative complication. The incidence of CSDH after neurosurgery was 0.8% (50/6613). Twenty-seven of the 50 patients with a past history of neurosurgery had undergone aneurysm clipping surgery. The incidence after clipping surgery was 2.4%. Twelve of these 27 cases also underwent ventriculoperitoneal shunting. Three patients had postoperative CSDH after arachnoid cyst opening and/or shunting. The incidence was highest at 7.5%. Three patients had postoperative CSDH after brain tumour surgery. The incidence was low at 0.4%. However, the ventricular cerebrospinal fluid (CSF) space was opened during tumour removal in 2 of these 3 patients.Communication of the subarachnoid space to the subdural space is considered to be one of the causative factors and excessive CSF shunting facilitates formation of CSDH after neurological surgery. Repair of arachnoid tearing during neurosurgery and avoidance of excessive CSF shunting may reduce the risk of CSDH after neurosurgery.