Management of Acute Subdural Hematomas from Aneurysmal Rupture
Management of Acute Subdural Hematomas from Aneurysmal Rupture
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动脉瘤破裂引起的急性硬膜下血肿的治疗
DOI：
10.1017/s031716710004573x
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发表时间：
1984
期刊：
影响因子：
--
通讯作者：
F. Durity
中科院分区：
文献类型：
--
作者：
B. Weir;Terence Myles;M. Kahn;F. Maroun;D. Malloy;B. Benoit;M. McDermott;D. Cochrane;G. Mohr;G. Ferguson;F. Durity
摘要：由破裂动脉瘤（RA）引起的硬膜下血肿（SDH）比脑内（ICH）血肿或蛛网膜下腔（SAH）或脑室内出血（IVH）少见得多。随着计算机断层扫描，术前诊断现在更频繁。作者从1980年和1981年11个医疗中心收治的897例RA中收集了18例。这些患者中有9例（50%）在出院前死亡。4例（22%）接受手术并于术后死亡，9例（50%）接受手术并存活。13例（72%）患者术前表现为瞳孔不等、意识下降和单侧无力。8例（89%）死亡病例显示术前疝形成，而仅5例（56%）存活病例显示术前疝形成。血管痉挛所致迟发性缺血的总发生率为11%（2例）。死亡的患者在入院时CT扫描上有更大的中线移位和更大的SDH。这些患者中有16例（89%）为女性。13例（72%）颈内动脉瘤破裂。所有血肿均为单侧均匀高密度，凸面血肿呈新月形。17例（94%）在硬膜下腔以外的位置有血液证据。如果患者有可能挽救并且中线移位，则可能应立即排空SDH并在同一手术中夹闭动脉瘤，因为发生小脑幕疝对结局有不良影响。
ABSTRACT: Subdural hematomas (SDH) from ruptured aneurysm (RA) are much less common than intracerebral (ICH) hematomas or subarachnoid (SAH) or intraventricular hemorrhage (IVH). With computerized tomography, preoperative diagnosis is now made more often. The authors have collected 18 such cases from a review of 897 cases of RA admitted to eleven medical centers in 1980 and 1981. Nine (50%) of these patients died prior to discharge from hospital. Four (22%) had surgery and died postoperatively and 9 (50%) were operated upon and survived. Thirteen (72%) of the patients showed anisocoria, decreased consciousness and unilateral weakness prior to surgery. Eight (89%) of the fatalities had shown preoperative herniation as opposed to only 5 (56%) of the survivors. The overall incidence of delayed ischemia due to vasospasm was 11% (2 cases). Those who died had greater midline shift and larger SDH on the admission CT scan. Sixteen (89%) of these patients were female. Thirteen (72%) had ruptured aneurysms on the internal carotid artery. All of these hematomas were unilateral and uniformly hyperdense, and the convexity hematomas were crescentic in shape. Seventeen (94%) had evidence of blood in locations other than the subdural space. If the patient is potentially salvageable and has a midline shift, the SDH should probably be evacuated immediately and the aneurysm clipped at the same operation since the development of a tentorial herniation has such an adverse effect on outcome.