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Abstract：
BACKGROUND: The bone holes in the skull during surgical drainage were accurately located at the site of the MMA. The MMA was severed, and the hematoma was removed intraoperatively; furthermore, surgical drainage removed the pathogenic factors of CSDH. This study aimed to describe and compare the results of the new treatment with those of traditional surgical drainage, and to investigate the relevance of this approach.
METHODS: From December 2021 to June 2023, 72 patients were randomly assigned to the observation group and the control group. The control group was treated with traditional surgical drainage, while the observation group was treated with DSA imaging to accurately locate the bone holes drilled in the skull on the MMA trunk before traditional surgical drainage. The MMA trunk was severed during the surgical drainage of the hematoma. The recurrence rate, time of indwelling drainage tube, complications, mRS, and other indicators of the two groups were compared, and the changes of cytokine components and imaging characteristics of the patients were collected and analyzed.
RESULTS: Overall, 27 patients with 29-side hematoma in the observation group and 45 patients with 48-side hematoma in the control group were included in the study. The recurrence rate was 0/29 in the observation group and 4/48 in the control group, indicating that the recurrence rate in the observation group was lower than in the control group (P = .048). The mean indwelling time of the drainage tube in the observation group was 2.04 ± 0.61 days, and that in the control group was 2.48 ± 0.61 days. The indwelling time of the drainage tube in the observation group was shorter than in the control group (P = .003). No surgical complications were observed in the observation group or the control group. The differences in mRS scores before and after operation between the observation group and the control group were statistically significant (P < .001). The concentrations of cytokine IL6/IL8/IL10/VEGF in the hematoma fluid of the observation and control groups were significantly higher than those in venous blood (P < .001). After intraoperative irrigation and drainage, the concentrations of cytokines (IL6/IL8/IL10/VEGF) in the subdural hematoma fluid were significantly lower than they were preoperatively. In the observation group, the number of MMA on the hematoma side (11/29) before STA development was higher than that on the non-hematoma side (1/25), and the difference was statistically significant (P = .003).
CONCLUSIONS: In patients with CSDH, accurately locating the MMA during surgical trepanation and drainage, severing the MMA during drainage, and properly draining the hematoma, can reduce the recurrence rate and retention time of drainage tubes, thereby significantly improving the postoperative mRS Score without increasing surgical complications.
METHODS: From December 2021 to June 2023, 72 patients were randomly assigned to the observation group and the control group. The control group was treated with traditional surgical drainage, while the observation group was treated with DSA imaging to accurately locate the bone holes drilled in the skull on the MMA trunk before traditional surgical drainage. The MMA trunk was severed during the surgical drainage of the hematoma. The recurrence rate, time of indwelling drainage tube, complications, mRS, and other indicators of the two groups were compared, and the changes of cytokine components and imaging characteristics of the patients were collected and analyzed.
RESULTS: Overall, 27 patients with 29-side hematoma in the observation group and 45 patients with 48-side hematoma in the control group were included in the study. The recurrence rate was 0/29 in the observation group and 4/48 in the control group, indicating that the recurrence rate in the observation group was lower than in the control group (P = .048). The mean indwelling time of the drainage tube in the observation group was 2.04 ± 0.61 days, and that in the control group was 2.48 ± 0.61 days. The indwelling time of the drainage tube in the observation group was shorter than in the control group (P = .003). No surgical complications were observed in the observation group or the control group. The differences in mRS scores before and after operation between the observation group and the control group were statistically significant (P < .001). The concentrations of cytokine IL6/IL8/IL10/VEGF in the hematoma fluid of the observation and control groups were significantly higher than those in venous blood (P < .001). After intraoperative irrigation and drainage, the concentrations of cytokines (IL6/IL8/IL10/VEGF) in the subdural hematoma fluid were significantly lower than they were preoperatively. In the observation group, the number of MMA on the hematoma side (11/29) before STA development was higher than that on the non-hematoma side (1/25), and the difference was statistically significant (P = .003).
CONCLUSIONS: In patients with CSDH, accurately locating the MMA during surgical trepanation and drainage, severing the MMA during drainage, and properly draining the hematoma, can reduce the recurrence rate and retention time of drainage tubes, thereby significantly improving the postoperative mRS Score without increasing surgical complications.
摘要：
背景：手术引流过程中颅骨中的骨孔精确定位在MMA的部位。MMA被切断了,术中清除血肿；此外，手术引流消除了CSDH的致病因素。这项研究旨在描述和比较新的治疗与传统的外科引流的结果，并调查这种方法的相关性。
方法：从2021年12月至2023年6月，将72例患者随机分为观察组和对照组。对照组采用传统手术引流,观察组采用DSA成像技术，在传统手术引流前准确定位MMA躯干上颅骨上钻的骨孔。在血肿的手术引流期间切断了MMA干。复发率,留置引流管的时间,并发症,mRS,等指标进行比较,收集并分析患者的细胞因子成分变化及影像学特征。
结果：总体而言，将观察组27例29侧血肿患者和对照组45例48侧血肿患者纳入研究。观察组复发率为0/29,对照组复发率为4/48。提示观察组复发率低于对照组(P=0.048)。观察组引流管平均留置时间为2.04±0.61天,对照组为2.48±0.61天。观察组引流管留置时间短于对照组(P=.003)。观察组和对照组均未出现手术并发症。观察组与对照组手术前后mRS评分差异均有统计学意义(P<.001)。观察组和对照组血肿液中细胞因子IL6/IL8/IL10/VEGF浓度明显高于静脉血(P<0.001)。术中冲洗和引流后，硬膜下血肿液中细胞因子（IL6/IL8/IL10/VEGF）的浓度明显低于术前。在观察组中,STA发展前血肿侧（11/29）的MMA数量高于非血肿侧（1/25），差异有统计学意义(P=.003)。
结论：在CSDH患者中，在手术钻孔和引流过程中精确定位MMA，在排水期间切断MMA，并适当地排出血肿，可以减少引流管的复发率和保留时间，从而显著提高术后mRS评分而不增加手术并发症。
方法：从2021年12月至2023年6月，将72例患者随机分为观察组和对照组。对照组采用传统手术引流,观察组采用DSA成像技术，在传统手术引流前准确定位MMA躯干上颅骨上钻的骨孔。在血肿的手术引流期间切断了MMA干。复发率,留置引流管的时间,并发症,mRS,等指标进行比较,收集并分析患者的细胞因子成分变化及影像学特征。
结果：总体而言，将观察组27例29侧血肿患者和对照组45例48侧血肿患者纳入研究。观察组复发率为0/29,对照组复发率为4/48。提示观察组复发率低于对照组(P=0.048)。观察组引流管平均留置时间为2.04±0.61天,对照组为2.48±0.61天。观察组引流管留置时间短于对照组(P=.003)。观察组和对照组均未出现手术并发症。观察组与对照组手术前后mRS评分差异均有统计学意义(P<.001)。观察组和对照组血肿液中细胞因子IL6/IL8/IL10/VEGF浓度明显高于静脉血(P<0.001)。术中冲洗和引流后，硬膜下血肿液中细胞因子（IL6/IL8/IL10/VEGF）的浓度明显低于术前。在观察组中,STA发展前血肿侧（11/29）的MMA数量高于非血肿侧（1/25），差异有统计学意义(P=.003)。
结论：在CSDH患者中，在手术钻孔和引流过程中精确定位MMA，在排水期间切断MMA，并适当地排出血肿，可以减少引流管的复发率和保留时间，从而显著提高术后mRS评分而不增加手术并发症。
