Neuroendoscopic surgery for failure of burr hole craniotomy in patients with chronic subdural hematoma
10.3760/cma.j.issn.1671-8925.2019.09.006
- VernacularTitle:慢性硬膜下血肿患者钻孔置管引流失败后再次行神经内镜下血肿清除术的疗效分析
- Author:
Pengfeng ZHENG
1
;
Zhangya LIN
;
Guangming ZENG
;
De WEI
Author Information
1. 福建省立医院南院神经外科
- Keywords:
Chronic subdural hematoma;
Drilling drainage;
Neuroendoscopy;
Hematoma clearance
- From:
Chinese Journal of Neuromedicine
2019;18(9):910-913
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the reasons of failure of burr hole craniotomy with drainage in patients with chronic subdural hematoma (CSDH) and advantages of survived neuroendoscopic surgery. Methods One hundred patients with CSDH, admitted to our hospital from May 2015 to May 2019, were enrolled. All patients were initially treated by burr hole craniotomy with drainage; 15 showed drainage failure and received survived neuroendoscopic hematoma evacuation. The preoperative and postoperative clinical features and treatment efficacy of these 15 patients were analyzed. Results Out of the 15 failed patients, 6 had drainage tube misplacement, and the other 9 showed drainage obstacle with separated hematoma. In 6 with drainage tube misplacement, 2 had drainage tube placed into the brain tissues, 3 had drainage tube located in the subendothelium of the hematoma, and one had drainage tube located outside the hematoma. Fifteen patients underwent neuroendoscopic hematoma resection, and the curative effect was significant. After 6 months of follow-up, the hematoma disappearance. Two patients were left with limb weakness due to catheter injury and brain tissues during the initial operation. Glasgow outcome scale indicated good prognosis in the remaining 13 patients. Conclusions Burr hole craniotomy should be standardized, and the drainage tube should be located in the hematoma cavity and thorough rinse should be performed. Neuroendoscopic hematoma evacuation is an effective remedy for failure of the first drilling and drainage surgery.
