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Hole drainage of chronic subdural hematoma causes and prevention of complications


Age group to as many elderly patients may have a clear history of head injury, a small number of white hair. Hole drainage,[link widoczny dla zalogowanych], surgical safety, efficacy, and complications. 1994 to 1999, our department treated 96 patients with chronic subdural hematoma, drainage holes are used. 1l 1 General clinical data of 72 cases superfluous material men. 24 female; age of l ~ 86 years old. People's homes are headache, vomiting 60 cases, language barriers l5 cases, limb weakness or partial juvenile side of 40 cases, 4 cases of mental deterioration were head CT showed hematoma on the screen, unilateral 90 cases. Bilateral 6; hematoma volume of 40 ~ 140ml. L. 2 surgical methods are closed drainage hole, repeatedly washed intraoperative and postoperative} fI-type drain 48 - 72h after extubation. Regardless of results of 87 cases after L3 have different degrees of intracranial hypertension symptom relief, limb movement disorder and awareness of significant improvement: 9 patients with clinical symptoms did not improve or worsen, the cerebrospinal fluid and cranial CT examination confirmed the occurrence of complications: intracranial infection low intracranial pressure, epidural hematoma,[link widoczny dla zalogowanych], cranial contusion of the l cases, 2 cases of tension pneumocephalus skull. 3 cases of recurrence of subdural hematoma. Conservative treatment or secondary surgery, 2 patients at discharge contralateral hemiparesis. Side of the body hypoesthesia and mental deterioration of the l cases. 92 patients recovered. 2 to discuss the group 2.1 cerebral contusion in 1 case. Because of drainage tube drainage tube inserted into brain tissue or hard, rebound in brain tissue of patients after cerebral contusion and hematoma caused visceral cavity thin line repeatedly washing cause brain tissue damage. Therefore, intraoperative drainage holes should be large (diameter> 25cm), drainage tube should be soft, be gentle operative technique. Once extubated immediately cerebral contusion and given symptomatic treatment. Necessary, surgical treatment is required. 2.2 hematoma recurrence has been reported ... CSDH cone drainage rate was 8%, the group 3 patients. Now that ¨ ~ 3 hematoma fluid of high permeability and fibrin degradation products increased. Hyperfunction of the fiber system, causing chronic hematoma endometrial fluid leakage, bleeding caused hematoma recurrence. There may be patients with blood diseases. Reduced fibrinolysis should be given only after closing gather in harvest date: 2,000,[link widoczny dla zalogowanych],411. I3 of the third unit of Bengbu, Anhui Province Hospital, Neurosurgery, Kunming, 233000, China Author: Ma Ji (1971 a), male. Anhui Bengbu people. Residents of medicines and encourage patients to blood or supplement the water permeability of liquid to speed up brain tissue rebound. Once the recurrence confirmed by brain CT treatment is required craniotomy. 2.3 epidural hematoma, 1 case in this group, because of intraoperative meningeal artery damage drilling and drainage of postoperative bleeding is not complete or sudden drop in intracranial pressure, leading to separation of the dura and the skull, the dura mater blood vessel rupture, so. Surgery should avoid dural blood vessels operating practices, intraoperative hematoma fluid should be slow release. Not too fast. Head CT confirmed to craniotomy therapy. Conservative treatment of symptomatic bleeding feasible. Cranial tension pneumocephalus 2.4 _4 1 case in this group, postoperative subdural hematoma drainage, prolonged pressure on brain tissue, brain tissue can not be re-compressed within a short time sheets, no significant residual cavity closed,[link widoczny dla zalogowanych], flush not complete ,[link widoczny dla zalogowanych], hematoma cavity fiber protein denaturation and washing materials when mixed cleaned air into the skull so the brain caused by gas drilling operations should be selected the highest part of the thickest hematoma. Rinse thoroughly after intraoperative injection of normal saline to the hematoma cavity. After open drainage, the patient should be absolute bed rest, reducing head high. If there is tension adjustable drain cranial location of gas exhaust gas. In severe cases, skull exhaust drilling feasible. 25 l of low intracranial pressure in patients of this group. Arachnoid drainage tube damage is mainly caused due to excessive CSF drainage. Surgical operation should be gentle, low intracranial pressure occurs when the drainage tube may be appropriate to raise and increased intracranial pressure or fluid drainage tubes were removed. 2.6 Intracranial infection may not strictly due to surgical sterilization. Drainage tube after disinfection or sterilization is not strictly a timely manner. F flow drainage tube after too long. Intraoperative and postoperative strict aseptic technique, strict sterile drainage, drainage bag regularly replaced, drainage tube drainage time shall not exceed 72h. Routine postoperative antibiotics. [
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