Hematoma subdural crônico tratamento cirúrgico e resultados em 96 pacientes operados

Salomão, J. Francisco; Leibinger, Renê D.; Lynch, José Carlos

doi:10.1590/S0004-282X1990000100013

Resumos

Os autores apresentam os resultados cirúrgicos de 96 casos de hematoma subdural crônico operados por meio de orifícios de trépano ou pequenas trefinas: 78 pacientes (81,3%) foram considerados curados, 6 (6,2%) apresentaram seqüelas e 12 (12,5%) faleceram. Os óbitos de natureza neurocirúrgica foram relacionados à intensidade do comprometimento neurológico por ocasião da cirurgia. A idade avançada associada à presença de doenças sistêmicas também teve influência na mortalidade. Seqüelas neurológicas foram observadas principalmente em pacientes submetidos a reoperações por reacúmulo do hematoma e em portadores de lesões bilaterais. Os autores chamam a atenção para a ocorrência de hipotensão intracraniana associada a colapso cerebral. A importância do diagnóstico precoce e cirurgia imediata são enfatizadas.

Ninety-six patients with chronic subdural hematoma were treated surgically and their clinical features presented in detail. Carotid angiography gave the correct diagnosis in all patients. CT scan was performed in 38 and was diagnostic in 92.1% of the cases. The clots were removed through burr-holes or small trephines: 78 (81.3%) patients were cured, 6 (6.2%) had permanent disabilities and 12 (12.5%) died. Operative mortality was related to the degree of neurological impairment, advanced age and systemic diseases. Neurologic sequelae were mostly related to reoperations due to recurrence of the hematoma and bilateral clots, as well. Low intracranial pressure syndrome with brain colapse was seen in 3 cases and treated with lumbar injection of saline solution. The delay in diagnosis and operation as cause of bad outcome is stressed.

J. Francisco Salomão; Renê D. Leibinger; José Carlos Lynch

Serviço de Neurocirurgia, Hospital dos Servidores do Estado, INAMPS, Rio de Janeiro

RESUMO

Os autores apresentam os resultados cirúrgicos de 96 casos de hematoma subdural crônico operados por meio de orifícios de trépano ou pequenas trefinas: 78 pacientes (81,3%) foram considerados curados, 6 (6,2%) apresentaram seqüelas e 12 (12,5%) faleceram. Os óbitos de natureza neurocirúrgica foram relacionados à intensidade do comprometimento neurológico por ocasião da cirurgia. A idade avançada associada à presença de doenças sistêmicas também teve influência na mortalidade. Seqüelas neurológicas foram observadas principalmente em pacientes submetidos a reoperações por reacúmulo do hematoma e em portadores de lesões bilaterais. Os autores chamam a atenção para a ocorrência de hipotensão intracraniana associada a colapso cerebral. A importância do diagnóstico precoce e cirurgia imediata são enfatizadas.

SUMMARY

Ninety-six patients with chronic subdural hematoma were treated surgically and their clinical features presented in detail. Carotid angiography gave the correct diagnosis in all patients. CT scan was performed in 38 and was diagnostic in 92.1% of the cases. The clots were removed through burr-holes or small trephines: 78 (81.3%) patients were cured, 6 (6.2%) had permanent disabilities and 12 (12.5%) died. Operative mortality was related to the degree of neurological impairment, advanced age and systemic diseases. Neurologic sequelae were mostly related to reoperations due to recurrence of the hematoma and bilateral clots, as well. Low intracranial pressure syndrome with brain colapse was seen in 3 cases and treated with lumbar injection of saline solution. The delay in diagnosis and operation as cause of bad outcome is stressed.

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Dr. J. Francisco Salomão - Av. N. S. Copacabana 1018/608 - 22060 Rio de Janeiro RJ - Brasil

1. Ambrosetto C - Post-traumatic subdural hematoma: further observations on nonsurgical treatment. Arch Neurol 6:287, 1962.
2. Bender MB - The medical treatment of chronic subdural hematoma. In Morley TP (ed): Current Controversies in Neurosurgery. Saunders, Philadelphia, 1976, pg 556.
3. Bender MB, Christoff N - Nonsurgical treatment of subdural hematomas. Arch Neurol 31:73, 1974.
4. Camel M, Grubb RL Jr - Treatment of chronic subdural hematoma by twist-drill craniostomy with continuous catheter drainage. J Neurosurg 65:183, 1986.
5. Cameron MM - Chronic subdural haematoma: a review of 114 cases. J Neurol Neurosurg Psychiat 41:834. 1978.
6. De Jesus PV, Poser CM - Subdural hematoma: a clinicopathological study of 100 cases. Postgrad Med 44:172, 1968.
7. Echlin FA, Sordillo SVR, Garvey TQ Jr - Acute, subacute and chronic subdural hematoma. J Am Med Assoc 161:1345, 1956.
8. Gjerris F, Schmidt K - Chronic subdural hematoma: surgery or mannitol treatment. J Neurosurg 40:639, 1974.
9. Holmes JMcD - Intracranial hypotension associated with subdural haematoma. Br Med J 1:1363, 1953.
10 Hubschmann OR - Twits-drill craniostomy in the treatment of chronic and subacute subdural hematomas in severely ill and elderly patients. Neurosurgery 6:233, 1980.
11 LaLonde AA, Gardner WJ - Chronic subdural hematoma: expansion of compressed cerebral hemisphere and relief of hypotension by spinal injection of physiologic saline solution. N Engl J Med 239:493, 1948.
12 Loew F - Management of chronic subdural haematomas and hygromas. In Krayenbuhl H (ed): Advances and Technical Standards in Neurosurgery, Vol 9. Springer, Wien, 1982, pg 113.
13 Loew F, Kivelitz R - Chronic subdural haematomas. In Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology, Vol 24 (part 11). North Holland, Amsterdam, 1976, Pg 297.
14. Markwalder TM - Chronic subdural hematomas: a review. J Neurosurg 54:637, 1981.
15. Markwalder TM, Steinsiepe KF, Rohner M, Reichenbach W, Markwalder H - The course of chronic subdural hematomas after burr-hole craniotomy and closed system drainage. J Neurosurg 39:390, 1981.
16. Mc Kissock W, Richardson A, Bloom WA - Subdural haematoma: a review of 398 cases. Lancet 1:1365, 1960.
17. Naganuma H, Fukamachi A, Kawakami M, Misumi S, Nakajima H, Wakao T - Spontaneous resolution of chronic subdural hematomas. Neurosurgery 19:794, 1986.
18. Negron RA, Tirado G, Zapater C - Simple bedside technique for evacuating chronic subdural hematomas: technical note. J Neurosurg 42:609, 1975.
19. Page F - Intracranial hypotension. Lancet 1:1, 1953.
20. Parkinson D, Chochinov H - Subdural hematomas: some observations on their postoperative course. J Neurosurg 17:901, 1960.
21. Perlmutter I - Subdural hematoma in older patients. J Am Med Assoc 176:212, 1961.
22. Robinson RG - The treatment of subacute and chronic subdural haematoma. Br Med J 1:21, 1955.
23. Robinson RG - Chronic subdural haematoma: surgical management in 133 patients. J Neurosurg 61:263, 1984.
24. Rosenbluth PR, Arias B, Quartetti EV, Carney AL - Current management of subdural hematoma. J Am Med Assoc 179:759, 1962.
25. Smyth HS, Livingstone KE - Ventricular infusion in the operative management of subdural hematoma. In Morley TP (ed): Current Controversies in Neurosurgery. Saunders, Philadelphia, 1976, pg 566.
26. Suzuki J - Mannitol treatment of subdural haematoma. J Neurosurg 41:785, 1974.
27. Svien HJ, Gelety JE - On the surgical management of encapsulated subdural hematoma. J Neurosurg 21:172, 1964.
28. Taarnhoj P - Chronic subdural hematomas: historical review and analysis of 60 cases. Cleveland Clin Quart 22:150, 1955
29. Tabaddor K, Shulman K - Definitive treatment of chronic subdural hematoma by twist--drill craniostomy and closed-system drainage. J Neurosurg 46:220, 1977.
30. Thomas LM, Gurdjian ES - Intracranial hematomas of traumatic origin. In Youmans JR (ed): Neurological Surgery, Vol 2. Saunders, Philadelphia, 1973, pg 960.
31. Tyson G, Strachan E, Newman P, Winn HR, Butler A, Jane J - The role of craniectomy in the treatment of chronic subdural hematomas. J Neurosurg 52:776, 1980.

Hematoma subdural crônico tratamento cirúrgico e resultados em 96 pacientes operados

Chronic subdural hematoma: surgical treatment and results in 96 operated patients

Datas de Publicação

Publicação nesta coleção
25 Maio 2011
Data do Fascículo
Mar 1990

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Ambrosetto C - Post-traumatic subdural hematoma: further observations on nonsurgical treatment. Arch Neurol 6:287, 1962.

[2] 2. Bender MB - The medical treatment of chronic subdural hematoma. In Morley TP (ed): Current Controversies in Neurosurgery. Saunders, Philadelphia, 1976, pg 556.

[3] 3. Bender MB, Christoff N - Nonsurgical treatment of subdural hematomas. Arch Neurol 31:73, 1974.

[4] 4. Camel M, Grubb RL Jr - Treatment of chronic subdural hematoma by twist-drill craniostomy with continuous catheter drainage. J Neurosurg 65:183, 1986.

[5] 5. Cameron MM - Chronic subdural haematoma: a review of 114 cases. J Neurol Neurosurg Psychiat 41:834. 1978.

[6] 6. De Jesus PV, Poser CM - Subdural hematoma: a clinicopathological study of 100 cases. Postgrad Med 44:172, 1968.

[7] 7. Echlin FA, Sordillo SVR, Garvey TQ Jr - Acute, subacute and chronic subdural hematoma. J Am Med Assoc 161:1345, 1956.

[8] 8. Gjerris F, Schmidt K - Chronic subdural hematoma: surgery or mannitol treatment. J Neurosurg 40:639, 1974.

[9] 9. Holmes JMcD - Intracranial hypotension associated with subdural haematoma. Br Med J 1:1363, 1953.

[10] 10 Hubschmann OR - Twits-drill craniostomy in the treatment of chronic and subacute subdural hematomas in severely ill and elderly patients. Neurosurgery 6:233, 1980.

[11] 11 LaLonde AA, Gardner WJ - Chronic subdural hematoma: expansion of compressed cerebral hemisphere and relief of hypotension by spinal injection of physiologic saline solution. N Engl J Med 239:493, 1948.

[12] 12 Loew F - Management of chronic subdural haematomas and hygromas. In Krayenbuhl H (ed): Advances and Technical Standards in Neurosurgery, Vol 9. Springer, Wien, 1982, pg 113.

[13] 13 Loew F, Kivelitz R - Chronic subdural haematomas. In Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology, Vol 24 (part 11). North Holland, Amsterdam, 1976, Pg 297.

[14] 14. Markwalder TM - Chronic subdural hematomas: a review. J Neurosurg 54:637, 1981.

[15] 15. Markwalder TM, Steinsiepe KF, Rohner M, Reichenbach W, Markwalder H - The course of chronic subdural hematomas after burr-hole craniotomy and closed system drainage. J Neurosurg 39:390, 1981.

[16] 16. Mc Kissock W, Richardson A, Bloom WA - Subdural haematoma: a review of 398 cases. Lancet 1:1365, 1960.

[17] 17. Naganuma H, Fukamachi A, Kawakami M, Misumi S, Nakajima H, Wakao T - Spontaneous resolution of chronic subdural hematomas. Neurosurgery 19:794, 1986.

[18] 18. Negron RA, Tirado G, Zapater C - Simple bedside technique for evacuating chronic subdural hematomas: technical note. J Neurosurg 42:609, 1975.

[19] 19. Page F - Intracranial hypotension. Lancet 1:1, 1953.

[20] 20. Parkinson D, Chochinov H - Subdural hematomas: some observations on their postoperative course. J Neurosurg 17:901, 1960.

[21] 21. Perlmutter I - Subdural hematoma in older patients. J Am Med Assoc 176:212, 1961.

[22] 22. Robinson RG - The treatment of subacute and chronic subdural haematoma. Br Med J 1:21, 1955.

[23] 23. Robinson RG - Chronic subdural haematoma: surgical management in 133 patients. J Neurosurg 61:263, 1984.

[24] 24. Rosenbluth PR, Arias B, Quartetti EV, Carney AL - Current management of subdural hematoma. J Am Med Assoc 179:759, 1962.

[25] 25. Smyth HS, Livingstone KE - Ventricular infusion in the operative management of subdural hematoma. In Morley TP (ed): Current Controversies in Neurosurgery. Saunders, Philadelphia, 1976, pg 566.

[26] 26. Suzuki J - Mannitol treatment of subdural haematoma. J Neurosurg 41:785, 1974.

[27] 27. Svien HJ, Gelety JE - On the surgical management of encapsulated subdural hematoma. J Neurosurg 21:172, 1964.

[28] 28. Taarnhoj P - Chronic subdural hematomas: historical review and analysis of 60 cases. Cleveland Clin Quart 22:150, 1955

[29] 29. Tabaddor K, Shulman K - Definitive treatment of chronic subdural hematoma by twist--drill craniostomy and closed-system drainage. J Neurosurg 46:220, 1977.

[30] 30. Thomas LM, Gurdjian ES - Intracranial hematomas of traumatic origin. In Youmans JR (ed): Neurological Surgery, Vol 2. Saunders, Philadelphia, 1973, pg 960.

[31] 31. Tyson G, Strachan E, Newman P, Winn HR, Butler A, Jane J - The role of craniectomy in the treatment of chronic subdural hematomas. J Neurosurg 52:776, 1980.