目的:评估发病率,相关因素,临床课程,动脉瘤性蛛网膜下腔出血(aSAH)患者的硬膜下积液的治疗选择。
方法:从2013年1月到2022年6月,336名连续的aSAH患者在我们中心接受了治疗。没有一例病例被排除在研究队列之外。入院时进行计算机断层扫描(CT)检查,手术后立即和术后第一天,随后在任何神经系统恶化的情况下,至少,每周一次,直到出院。随后的CT检查由康复机构的专家自行决定,转介医生,或者门诊的神经外科医生.
结果:入院时从CT开始的放射学随访时间为1至3,286天(平均,673±895天;中位数,150天)。84例(25%)发生了硬膜下积液。从最初的CT检查到该影像学发现的平均间隔为25±55天(中位数,8天;范围,0-362天)。多变量模型评估显示患者年龄>72岁(P<0.0001),脑脊液分流(P<0.0001),颅内动脉瘤破裂的显微手术夹闭(RIA;P<0.0001)与硬膜下积液的发生独立相关。84例中有54例(64%)硬膜下积液仅需要观察。出现中线移位(5例)或不出现(10例)的病灶大小增加与患者年龄<72岁相关(P=0.0398),去骨瓣减压术(P=0.0192),和脑脊液分流(P=0.0009),而在多变量模型中对这些因素的评估证实了仅CSF分流的独立关联(P=0.0003)。硬膜下积液的主动管理包括调节分流程控阀开启压力,颅骨修补术,外部硬膜下引流,或他们的组合。总的来说,在随访期间(平均,531±824天;中位数,119天;范围,2-3,285天)开始观察或应用治疗后,硬膜下积液显示其大小减少(50例)或稳定(34例),没有任何病变再次出现进展。
结论:在接受aSAH治疗的患者中,硬膜下积液的临床病程通常是有利的,但偶尔这些病变表现出进行性增大,无论是否出现中线移位,这需要积极的管理。
To evaluate the incidence, associated factors, clinical course, and management options of subdural hygroma in patients treated for aneurysmal subarachnoid hemorrhage (aSAH).
From January 2013 until June 2022, 336 consecutive patients with aSAH underwent treatment in our center. No one patient was excluded from the study cohort. Computed tomography (CT) examinations were performed at admission, immediately after surgery and on the first postoperative day, and subsequently in case of any neurologic deterioration or, at least, once per week until discharge from the hospital. Thereafter, CT examinations were at the discretion of specialists in the rehabilitation facility, referring physicians, or neurosurgeons at the outpatient clinic.
The length of radiologic follow-up starting from CT at admission ranged from 1 to 3286 days (mean, 673 ± 895 days; median, 150 days). Subdural hygromas developed in 84 patients (25%). An average interval until this imaging finding from the initial CT examination was 25 ± 55 days (median, 8 days; range, 0-362 days). Evaluation in the multivariate model showed that patient age ≥72 years (P < 0.0001), cerebrospinal fluid (CSF) shunting (P < 0.0001), and microsurgical clipping of ruptured intracranial aneurysm (RIA; P < 0.0001) are independently associated with the development of subdural hygroma. In 54 of 84 cases (64%), subdural hygromas required observation only. Increase of the lesion size with (5 cases) or without (10 cases) appearance of midline shift was associated with patient age <72 years (P = 0.0398), decompressive craniotomy (P = 0.0192), and CSF shunting (P = 0.0009), whereas evaluation of these factors in the multivariate model confirmed independent association of only CSF shunting (P = 0.0003). Active management of subdural hygromas included adjustment of the shunt programmable valve opening pressure, cranioplasty, external subdural drainage, or their combination. Overall, during follow-up (mean, 531 ± 824 days; median, 119 days; range, 2-3285 days) after the start of observation or applied treatment, subdural hygromas showed either decrease (50 cases) or stabilization (34 cases) of their sizes, and no one lesion showed progression again.
The clinical course of subdural hygromas in patients treated for aSAH is generally favorable, but occasionally these lesions show progressive enlargement with or without the appearance of midline shift, which requires active management.