Chronic subdural hemorrhage removal

Chronic subdural hematoma accounts for about 1% of cases of craniocerebral injury, accounting for about 10% of intracranial hematoma. Older people are better. In the past, it was thought that the formation of chronic subdural hematoma was due to plasma infiltration of the enveloped blood vessels, which increased the intraossear osmotic pressure, resulting in an ever-expanding volume of hematoma. Recent studies have shown that the mechanism of its formation is due to the continuous rupture of microvessels in the outer layer of the hematoma capsule and excessive fibrinolysis to promote hemorrhage, which gradually enlarges the volume of hematoma. Therefore, in addition to emptying the fluid in the capsule, it is necessary to wash the local fibrinolytic substance and the fibrin degradation product as much as possible by repeated washing with physiological saline, and then perform drainage. The surgical method of resection of the hematoma together with the cyst wall is not the first choice. It is only used when the wall of the capsule is abnormally thickened or calcified, and the drilling and drainage drainage is difficult to restore the compressed brain. . Treatment of diseases: senile chronic subdural hematoma Indication Because the volume of chronic subdural hematoma gradually increases, and can be cured by a simple surgical method of drilling and drainage, it is necessary to treat the patients with symptoms after chronic subdural hematoma. Contraindications 1. The amount of hematoma is too small, and there is no increase in intracranial pressure and symptoms of brain compression. 2. The hematoma has formed thick wall and even calcification, and the patient's general condition is not good, it is difficult to tolerate hematoma resection, can be regarded as a surgical contraindication. Surgical procedure Drilling irrigation drainage 1 Drill a hole in the posterior upper and lower front of the hematoma. 2 After the dura mater was opened, the catheter was placed in the hematoma cavity with two catheters, and washed repeatedly with physiological saline until the liquid flowing out was clear and colorless and transparent. 3 Then pull the anterior catheter out of the suture incision, retain the posterior catheter, and connect the ventricular drainage device for closed drainage. A single hole flushing method can also be used. That is, the scalp is cut into a small mouth of 3 to 5 mm at the thickest position of the hematoma, and the skull is drilled with a bone cone. Then, after the dura mater is pierced with a thick needle, a catheter is inserted into the paraglossal hole, and a trigeminal tube is connected to the hematoma cavity. Aspirate and rinse, and finally suture the incision with 1 needle. This method is simple and easy. 2. Bone craniotomy hematoma resection 1 According to the location of the hematoma, a large craniotomy was performed along the edge of the hematoma, and the flap was horseshoe-shaped. 2 flaps of the dura mater, turned to the midline. If the outer wall of the hematoma and the dura mater are dense and difficult to separate, they can be cut and turned together. 3 From the inside of the upper side of the hematoma, the capsule was gradually separated from the surface of the brain and excised. If the adhesion is dense and difficult to separate, a small envelope may be left, or only the outer envelope may be removed. 4 After strict hemostasis, suture the skull as usual. The drainage tube is built in the cavity. complication 1. Brain damage: caused by improper operation technique when placing the drainage tube, so it should be carefully operated. 2. Tension gas cranium: The cause and prevention measures have been as described above. 3. Subdural hematoma: mostly due to incomplete hemorrhage of the hematoma capsule, or a sharp drop in intracranial pressure after hematoma aspiration causes tearing of the bridge vein, and should be treated again in time. 4. Epidural hematoma: Most of the blood vessels between the dura mater and the skull are detached and tear caused by bleeding, and the peeling is continuously enlarged after bleeding. The hematoma should be removed by timely craniotomy.