神经内镜治疗慢性硬膜下血肿的研究进展

doi:10.3877/cma.j.issn.2095-9141.2023.01.011

慢性硬膜下血肿（CSDH）是好发于老年人的中枢神经系统疾病，传统的外科治疗方法为钻孔引流术，但部分患者血肿清除不彻底、术后复发率高，对于机化的血肿甚至需行骨瓣开颅手术。近年来研究发现，应用神经内镜的可视化特征能显著提高血肿清除率，降低术后并发症和复发率。本文就神经内镜治疗CSDH的最新研究进展作一综述。

关键词: 慢性硬膜下血肿, 神经内镜, 复发

Chronic subdural hematoma (CSDH) is a central nervous system disease that often occurs in the elderly. The traditional surgical treatment is burr hole drainage. However, the hematoma was not completely removed in some cases with high post-operative recurrence rates. For organized hematomas even craniotomy is required. In recent years, studies have found that the application of visualization features of neuroendoscopy can significantly improve the rate of hematoma clearance, and reduce the rate of postoperative complications and recurrence. This article reviews the recent progress of neuroendoscopic therapy for CSDH.

Key words: Chronic subdural hematoma, Neuro-endoscopy, Recurrence

[1]	Motiei-Langroudi R, Stippler M, Shi S, et al. Factors predicting reoperation of chronic subdural hematoma following primary surgical evacuation[J]. J Neurosurg, 2018, 129(5): 1143-1150. DOI: 10.3171/2017.6.JNS17130.
[2]	Chen S, Peng H, Shao X, et al. Prediction of risk factors for the evolution of traumatic subdural effusion into chronic subdural hematoma[J]. Neuropsychiatr Dis Treat, 2020, 16: 943-948. DOI: 10.2147/NDT.S245857.
[3]	Mersha A, Abat S, Temesgen T, et al. Outcome of chronic subdural hematoma treated with single burr hole under local anesthesia[J]. Ethiop J Health Sci, 2020, 30(1): 101-106. DOI: 10.4314/ejhs.v30i1.13.
[4]	苏高健,黄贤键.慢性硬膜下血肿的研究进展[J].中华神经创伤外科电子杂志, 2021, 7(5): 310-313. DOI: 10.3877/cma.j.issn.2095-9141.2021.05.012.
[5]	Du B, Xu J, Hu J, et al. A clinical study of the intra-neuroendoscopic technique for the treatment of subacute-chronic and chronic septal subdural hematoma[J]. Front Neurol, 2019, 10: 1408. DOI: 10.3389/fneur.2019.01408.
[6]	Yadav YR, Ratre S, Parihar V, et al. Endoscopic management of chronic subdural hematoma[J]. J Neurol Surg A Cent Eur Neurosurg, 2020, 81(4): 330-341. DOI: 10.1055/s-0039-1698388.
[7]	王超斌,胡钧涛.慢性硬膜下血肿发病机制研究进展[J].中国神经精神疾病杂志, 2021, 47(10): 628-632. DOI: 10.3969/j.issn.1002-0152.2021.10.012.
[8]	Hamou HA, Clusmann H, Schulz JB, et al. Chronic subdural hematoma[J]. Dtsch Arztebl Int, 2022, 119(12): 208-213. DOI: 10.3238/arztebl.m2022.0144.
[9]	Song P, Li Z, Ke Y, et al. A novel imaging classification system for the neuroendoscopic treatment of chronic subdural hematoma[J]. Am J Transl Res, 2021, 13(11): 12235-12248.
[10]	Ironside N, Nguyen C, Do Q, et al. Middle meningeal artery embolization for chronic subdural hematoma: a systematic review and meta-analysis[J]. J Neurointerv Surg, 2021, 13(10): 951-957. DOI: 10.1136/neurintsurg-2021-017352.
[11]	Ichimura S, Takahara K, Nakaya M, et al. Neuroendoscopic technique for recurrent chronic subdural hematoma with small craniotomy[J]. Turk Neurosurg, 2020, 30(5): 701-706. DOI: 10.5137/1019-5149.JTN.27918-19.4.
[12]	Májovský M, Masopust V, Netuka D, et al. Flexible endoscope-assisted evacuation of chronic subdural hematomas. Acta Neurochir (Wien), 2016, 158(10): 1987-1992. DOI: 10.1007/s00701-016-2902-5.
[13]	Rodziewicz GS, Chuang WC. Endoscopic removal of organized chronic subdural hematoma[J]. Surg Neurol, 1995, 43(6): 569-572, discussion572-573. DOI: 10.1016/0090-3019(95)00005-4.
[14]	Yadav YR, Ratre S, Parihar V, et al. Endoscopic management of chronic subdural hematoma[J]. J Neurol Surg A Cent Eur Neurosurg, 2020, 81(4): 330-341. DOI: 10.1055/s-0039-1698388.
[15]	关峰,彭伟澄,黄辉,等.应用软性神经内镜技术治疗慢性硬膜下血肿的疗效分析[J].中华医学杂志, 2019, 99(9): 695-699. DOI: 10.3760/cma.j.issn.0376-2491.2019.09.012.
[16]	Balevi M. Organized chronic subdural hematomas treated by large craniotomy with extended membranectomy as the initial treatment[J]. Asian J Neurosurg, 2017, 12(4): 598-604. DOI: 10.4103/ajns.AJNS_8_15.
[17]	Ishikawa T, Endo K, Endo Y, et al. Neuro-endoscopic surgery for multi-lobular chronic subdural hematoma[J]. No Shinkei Geka, 2017, 45(8): 667-675. DOI: 10.11477/mf.1436203572.
[18]	Fujimoto T, Morofuji Y, Takahira R, et al. Surgery for a refractory chronic subdural hematoma using an exoscope: a technical case report[J]. No Shinkei Geka, 2019, 47(4): 429-434. DOI: 10.11477/mf.1436203956.
[19]	Kawasaki T, Kurosaki Y, Fukuda H, et al. Flexible endoscopically assisted evacuation of acute and subacute subdural hematoma through a small craniotomy: preliminary results[J]. Acta Neurochir (Wien), 2018, 160(2): 241-248. DOI: 10.1007/s00701-017-3399-2.
[20]	Mahmood SD, Waqas M, Baig MZ, et al. Mini-craniotomy under local anesthesia for chronic subdural hematoma: an effective choice for elderly patients and for patients in a resource-strained environment[J]. World Neurosurg, 2017, 106: 676-679. DOI: 10.1016/j.wneu.2017.07.057.
[21]	Sahyouni R, Mahboubi H, Tran P, et al. Membranectomy in chronic subdural hematoma: meta-analysis[J]. World Neurosurg, 2017, 104: 418-429. DOI: 10.1016/j.wneu.2017.05.030.
[22]	Lee JY, Ebel H, Ernestus RI, et al. Various surgical treatments of chronic subdural hematoma and outcome in 172 patients: is membranectomy necessary?[J]. Surg Neurol, 2004, 61(6): 523-527, discussion527-528. DOI: 10.1016/j.surneu.2003.10.026.
[23]	Guo S, Gao W, Cheng W, et al. Endoscope-assisted surgery vs. Burr-hole craniostomy for the treatment of chronic subdural hematoma: a systemic review and meta-analysis[J]. Front Neurol, 2020, 11: 540911. DOI: 10.3389/fneur.2020.540911.
[24]	Zhang J, Chen J. The therapeutic effects of craniotomy versus endoscopic-assisted trepanation drainage for isolated chronic subdural haematoma (ICSH): A single-centre long-term retrospective comparison study. Brain Res Bull, 2020, 161: 94-97. DOI: 10.1016/j.brainresbull.2020.04.014.
[25]	Ichimura S, Takahara K, Nakaya M, et al. Neuroendoscopic technique for recurrent chronic subdural hematoma with small craniotomy[J]. Turk Neurosurg, 2020, 30(5): 701-706. DOI: 10.5137/1019-5149.JTN.27918-19.4.
[26]	Kramer A, Degenhartt X, Gutenberg A, et al. Risk factors for postoperative seizures in patients with chronic subdural haematomas[J]. Neurosurg Rev, 2022, 45(5): 3291-3298. DOI: 10.1007/s10143-022-01858-5.
[27]	Chavakula V, Yan SC, Huang KT, et al. Subdural pneumocephalus aspiration reduces recurrence of chronic subdural hematoma[J]. Oper Neurosurg (Hagerstown), 2020, 18(4): 391-397. DOI: 10.1093/ons/opz193.
[28]	You CG, Zheng XS. Postoperative pneumocephalus increases the recurrence rate of chronic subdural hematoma[J]. Clin Neurol Neurosurg, 2018, 166: 56-60. DOI: 10.1016/j.clineuro.2018.01.029.
[29]	Stanišic M, Pripp AH. A reliable grading system for prediction of chronic subdural hematoma recurrence requiring reoperation after initial burr-hole surgery[J]. Neurosurgery, 2017, 81(5): 752-760. DOI: 10.1093/neuros/nyx090.
[30]	Liu LX, Cao XD, Ren YM, et al. Risk factors for recurrence of chronic subdural hematoma: a single center experience[J]. World Neurosurg, 2019, 132: e506-e513. DOI: 10.1016/j.wneu.2019.08.089.
[31]	严超,杨明飞.慢性硬膜下血肿术后复发的研究进展[J].中华神经外科杂志, 2019, 35(3): 318-321. DOI: 10.3760/cma.j.issn.1001-2346.2019.03.020.
[32]	Hammer A, Tregubow A, Kerry G, et al. Predictors for recurrence of chronic subdural hematoma[J]. Turk Neurosurg, 2017, 27(5): 756-762. DOI: 10.5137/1019-5149.JTN.17347-16.1.
[33]	Poon MTC, Al-Shahi Salman R. Association between antithrombotic drug use before chronic subdural haematoma and outcome after drainage: a systematic review and meta-analysis[J]. Neurosurg Rev, 2018, 41(2): 439-445. DOI: 10.1007/s10143-017-0860-x.
[34]	Wang Y, Zhou J, Fan C, et al. Influence of antithrombotic agents on the recurrence of chronic subdural hematomas and the quest about the recommencement of antithrombotic agents: a meta-analysis[J]. J Clin Neurosci, 2017, 38: 79-83. DOI: 10.1016/j.jocn.2016.12.001.
[35]	曹德茂,武永康,王友伟,等.微创穿刺联合口服阿托伐他汀治疗慢性硬膜下血肿的疗效分析[J].中华神经创伤外科电子杂志, 2016, 2(2): 83-85. DOI: 10.3877/cma.j.issn.2095-9141.2016.02.005.
[36]	Ridwan S, Bohrer AM, Grote A, et al. Surgical treatment of chronic subdural hematoma: predicting recurrence and cure[J]. World Neurosurg, 2019, 128: e1010-e1023. DOI: 10.1016/j.wneu.2019.05.063.
[37]	Wakuta N, Abe H, Fukuda K, et al. Feasibility and safety of endoscopic procedure in burr-hole surgery for chronic subdural hematoma in patients of very advanced age[J]. World Neurosurg, 2020, 134: e1037-e1046. DOI: 10.1016/j.wneu.2019.11.080.
[38]	Qiu S, Zhuo W, Sun C, et al. Effects of atorvastatin on chronic subdural hematoma: a systematic review[J]. Medicine (Baltimore), 2017, 96(26): e7290. DOI: 10.1097/MD.0000000000007290.
[39]	Yan K, Gao H, Zhou X, et al. A retrospective analysis of postoperative recurrence of septated chronic subdural haematoma: endoscopic surgery versus burr hole craniotomy[J]. Neurol Res, 2017, 39(9): 803-812. DOI: 10.1080/01616412.2017.1321709.
[40]	吴江,卜计源,孙亮,等.神经内镜联合显微镜的双镜技术在松果体区脑膜瘤显微手术中的应用[J].中华医学杂志, 2022, 102(11): 821-824. DOI: 10.3760/cma.j.cn12137-20210719-01605.

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