Lancet Neuro:外伤性急性硬膜下血肿如何选?手术or保守治疗

2022-06-30 MedSci原创 MedSci原创

对于急性硬膜下血肿患者,可以考虑最初的保守治疗。

目前已被证实,但创伤性急性硬膜下血肿的急性手术是基于低级别的证据。为了比较急性硬膜下血肿的急性手术切除策略和初始保守治疗策略的有效性,近期发表在Lancet Neurology杂志上的研究给出了结论。

来自荷兰大学神经外科中心的专家利用欧洲创伤性脑损伤神经创伤有效性研究协作组(CENTER-TBI)参与者的数据进行了前瞻性、观察性、比较有效性研究。纳入了之前没有严重神经系统疾病、在脑外伤24小时内出现急性硬膜下血肿的患者。主要终点是用格拉斯哥扩展结果量表评定的6个月时的功能结果。

2014年12月19日至2017年12月17日期间,4559名脑外伤患者被纳入CENTER-TBI,其中1407名(31%)出现急性硬膜下血肿,并被纳入研究。336名(24%)患者进行了急性手术,其中245名(73%)患者进行了开颅手术,91名(27%)患者进行了减压颅骨切除术。

在最初的保守治疗后,107名(11%)患者进行延迟的减压性颅骨切除术或开颅手术(n=982)。各个中心接受急性手术的患者比例从5.6%到51.5%不等,不同中心随机接受急性手术的概率最多相差2倍(MOR为1.8)。其中,中心倾向于急性手术而不是最初的保守治疗与功能结果的改善无关。

该研究结果显示,由于首选方法的不同,对具有类似特征的急性硬膜下血肿患者的治疗方法也不同。与最初的保守治疗相比,选择积极的急性手术切除的治疗策略与更好的功能结果没有关系。因此,对于急性硬膜下血肿患者,如果神经外科医生认为急性手术比保守治疗没有明显优势,可以考虑最初的保守治疗。

 

参考文献:

Surgery versus conservative treatment for traumatic acute subdural haematoma: a prospective, multicentre, observational, comparative effectiveness study

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    2022-06-23 younei

    lancet上果然牛,感谢梅斯更新及时

    0

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本例捕捉到了动脉瘤实时破裂,血液直接进入硬膜下间隙,而未发现伴蛛网膜下腔或脑内出血。

PHILIPS每日一例:MRI 假象逼真:疑似硬膜下血肿

原发性硬脑膜淋巴瘤:十分罕见,在所有的非霍奇金淋巴瘤中,PDL 出现的比例低于 0.1%,在原发性中枢神经系统肿瘤中低于 3%。

一图读懂硬膜下水肿

硬膜下水肿图解

颅脑CT怎么判读比较高效+准确?

脑出血的辅助检查首选头颅CT,判读颅脑CT首先要寻找可能的出血问题。

硬膜下和硬膜外血肿清除术的围术期挑战

头部外伤后,出血可能积聚在颅骨内表面和 硬脑膜之间形成硬膜外血肿,积聚在硬脑膜和蛛网膜之间形成硬膜下血肿,也可能积聚在蛛网膜下隙,或脑实质内(挫伤性出血和脑内血肿)。

额叶占位性病变合并出血、硬膜下血肿、蛛网膜下血肿、脑疝、癫痫患者典型病例1例

脑肿瘤卒中是指脑肿瘤在生长过程中由于多种因素而发生的肿瘤出血,其常侵及周围脑组织形成颅内血肿或蛛网膜下腔出血。脑肿瘤卒中在临床上并不少见,它约占同期所有颅内出血的1%~10%,