Mechanism Of Chronic Subdural Hematomas,Postoperative Complications And Recurrence Reason Analysis

Objective:To research the occur mechanism of chronic subdural hematomas,postoperative complications after the use of hole drainage in patients with CSDH,and the reason of recurrence.Methods:Through the literature research combined with clinical research,analyze the mechanism of chronic subdural hematomas.Retrospective analyze the clinical material of 255 cases of patients with CSDH and treated with burr-hole craniostomy and irrigation with closed system drainage from January 2006 to December 2011 in our hospital.The main research analysis contained the causes of CSDH of patients,the difference of the clinical symptoms between patients in different age paragraph.The diagnosis method for patients was CT scan,and patients with CSDH were divided into different type through the result of CT scan.Research what type of CSDH was easy to be misdiagnosed and recurrence.Analyze the occurrence of complications and recurrence,the cause of occurrence and how to prevent and treat.Results:1.Cause:there were 161 cases(63.1%)of CSDH patients who had clear head trauma history,including 38 cases(14.9%)traffic accidents,25 cases(9.8%)blow hurts and 89 cases(38.4%)fall hurts.8 cases(3.I%)of CSDH patients was caused by hydrocephalus surgery.10 cases(3.9%)of CSDH patients was caused by blood coagulation function drops and remaining 76 cases(29.8%)of CSDH patients had no obvious reason for the disease.2.Clinical symptoms:there were certain difference of clinical symptoms between patients who were ?60 years and patients who were<60 years.The most common clinical symptoms in patients who were<60 years were headache,followed by numbness,the incidence rates were 70.5%and 19.3%respectively.While the most common clinical symptoms in patients who were ?60 years were numbness.followed by headache,the incidence rates were 50.9%and 27.5%respectively.3.Radiographic inspection:all the 255 patients were performed CT inspection,according to the hematoma density of patients,the hematoma can be divided into five types:low density type(75 cases,29.4%),equal density type(51 cases,20.0%),high density type(10 cases,3.9%),hybrid density type(113 cases,44.3%)and separation type(6 cases,2.4%).Equal density was easy to be misdiagnosed.4.Postoperative complications:251 cases in all 255 cases of CSDH patients were cured,and 4 cases died.The causes of death included diffuse intravascular coagulation(1 cases),pulmonary infection(2 cases)and epilepsy(1 cases).There were totally 19 cases of complications,include 3 cases of epilepsy,4 cases of stroke,11 cases of recurrent hematoma and 1 case of tension disposition cranial.Conclusion:1.The mechanism of CSDH included:subdural small and constant bleeding,bridge vascular fracture making subdural fluid collection(SFC)into CSDH,SFC evolution causing arachnoid active repair process to induce new capillary hemorrhage,vascular endothelial growth factor content increased,fibrinolytic hyper function,and acute subdural hematoma(ASDH).2.Most patients with CSDH had a clear etiology.The most common etiology for CSDH was head injury,followed by coagulation dysfunction and hydrocephalus shunts,but there was still twenty-nine point eight percents of patients whose etiology remained unclear.3.The presentation of CSDH was different between younger(<60 years)and older patients(?60 years)and there was no special presentation of CSDH.4.There were five types of appearance on CT scans of CSDH and isodense type was more likely to be misdiagnosised.A contract-enhanced CT scans or MRI examination might be necessary in the evaluation of isodense CSDH.5.Although the treatment of CSDH with burr-hole craniostomy and irrigation with closed system drainage was a safe and simple method,postoperative complications might be encounted and motality still existed in some patients.