Hematoma subdural crônico: análise de 35 casos

Araújo, João Flavio M.; Iafigliola, Maria Gracia; Balbo, Roque José

doi:10.1590/S0004-282X1996000100012

Resumos

Os autores relatam 35 casos com diagnóstico de hematoma subdural crônico, operados no período de janeiro-1988 a março-1995. A idade dos pacientes variou entre 19 e 80 anos. Foram eles agrupados retrospectivamente segundo a escala de Bender. Quanto ao tratamento cirúrgico, foram empregadas duas técnicas: craniotomia com membranectomia e dupla trepanação com instilação de solução salina na cavidade ocupada pelo hematoma. O índice de mortalidade entre os pacientes submetidos à craniotomia foi 16,6% e nos pacientes submetidos à trepanação foi nulo. Dentre os pacientes que faleceram, 80% encontravam-se em grau III ou IV na escala de Bender. O hematoma subdural crônico apresenta até os dias atuais alguns aspectos controversos, como quanto à sua fisiopatologia e ao tratamento cirúrgico adequado.

hematoma subdural crônico; craniotomia; trepanação

Thirty five patients with chronic subdural hematoma were treated surgically between 1988 and 1995. The patients, aged 19 to 80 years, were graded retrospectively according to the Bender scale. The clots were removed via burr-holes with irrigation of the subdural space to ensure as complete an evacuation of subdural colletion, and craniotomy with membranectomy. The mortality rate was 16.6% with craniotomy and 0% with burr-hole. The patients who died, 80% were in grade III or IV. The pathogenesis and surgical treatment of chronic subdural hematoma has been controversial, and still remains obscure.

chronic subdural hematoma; craniotomy; burr-hole evacuation

João Flavio M. Araújo^II; Maria Gracia Iafigliola^III; Roque José Balbo^I

^IDepartamento de Neuro-Psiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas Departamento de Neurologia do Hospital Vera Cruz: Professor Adjunto

^IIDepartamento de Neuro-Psiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas Departamento de Neurologia do Hospital Vera Cruz: Neurocirurgião

^IIIDepartamento de Neuro-Psiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas Departamento de Neurologia do Hospital Vera Cruz: Médica Residente

RESUMO

Os autores relatam 35 casos com diagnóstico de hematoma subdural crônico, operados no período de janeiro-1988 a março-1995. A idade dos pacientes variou entre 19 e 80 anos. Foram eles agrupados retrospectivamente segundo a escala de Bender. Quanto ao tratamento cirúrgico, foram empregadas duas técnicas: craniotomia com membranectomia e dupla trepanação com instilação de solução salina na cavidade ocupada pelo hematoma. O índice de mortalidade entre os pacientes submetidos à craniotomia foi 16,6% e nos pacientes submetidos à trepanação foi nulo. Dentre os pacientes que faleceram, 80% encontravam-se em grau III ou IV na escala de Bender. O hematoma subdural crônico apresenta até os dias atuais alguns aspectos controversos, como quanto à sua fisiopatologia e ao tratamento cirúrgico adequado.

Palavras-chaves: hematoma subdural crônico, craniotomia, trepanação.

ABSTRACT

Thirty five patients with chronic subdural hematoma were treated surgically between 1988 and 1995. The patients, aged 19 to 80 years, were graded retrospectively according to the Bender scale. The clots were removed via burr-holes with irrigation of the subdural space to ensure as complete an evacuation of subdural colletion, and craniotomy with membranectomy. The mortality rate was 16.6% with craniotomy and 0% with burr-hole. The patients who died, 80% were in grade III or IV. The pathogenesis and surgical treatment of chronic subdural hematoma has been controversial, and still remains obscure.

Key words:chronic subdural hematoma, craniotomy, burr-hole evacuation.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 2-setembro-1995.

Dr. João Flavio de Mattos Araújo - Departamento de Neurologia, Hospital Vera Cruz - Avenida Andrade Neves 402 - 13013-900 Campinas SP - Brasil.

1. Bender MB, Christoff N. Non surgical treatment of subdural hematomas. Arch Neurol 1974, 31:73-79.
2. Benzei EC, Bridges RM, Hadden TA, Orrison WW. The single burr hole technique for the evacuation of non-acute subdural hematomas. Trauma 1994, 36:190-194.
3. Cameron MM. Chronic subdural hematoma: a review of 114 cases. J Neurol. Neurosurg Psychiatry 1978; 41:834-839.
4. Choudhuty AR. Avoidable factors that contribute to complications in the surgical treatment of chronic subdural haematoma. Acta Neurochir (Wien) 1994; 129:15-19.
5. Grisoli F, Graziani N, Peragut JC, Vincentelli F, Fabrizi AP, Caruso G, Bellard S. Perioperative lumbar injection of Ringer's lactate solution in chronic subdural hematomas: a series of 100 cases. Neurosurgery 1988; 23:616-621
6. Harden; A, Eggert HR, Weigel. Behandlung des chronischen Subduralhaematoms mit externer Geschlossener drainege. Neurochirurgia (Stuttg) 1982, 25:147-152.
7. Hill NC, Goldestein NP, Mckenziel BF. Cérebro spinal fluid proteins, glycoproteins and lipoproteins in obstructive lesions of the cental nervous system. Brain 1959; 82:581-593.
8. Hosoda K, Norihiko T, Masumura M, Matsumoto S, Maeda F. Magnetic resonance images of chronic subdural hematomas. J Neurosurg 1987; 67:677-683
9. Loew F, Kivelitz R. Chronic subdural hematomas. In Vinken PF, Bruyn GW (eds). Handbook of Clinical Neurology. New York: Elsevier, 1976, Vol 24, pt II.
10. Markwalder TM. Chronic subdural hematomas: a review. J Neurosurg 1981; 54:637 o45.
11. Markwalder TM, Reulen HJ. Influence of neomembranes organisation, cortical expansion and subdural pressure on the post-operative course of chronic subdural haematoma: an analysis f 201 cases. Acta Neurochir ( Wien ) 1986; 79:100-106.
12. Robinson RG. Chronic subdural hematoma: surgical management in 133 patients. J Neuros rg 1984; 61:263-268.
13. Rychlicki F, Recchioni MA, Burchianti M, Marcolini P, Messori A, Papo I. Per rutaneous twist-drill craniostomy for the treatment of chronic subdural haematoma. Acta Neurochir ( Wien ) 1991; 113:38-41.
14. Sato S, Suzuky J. Ultrastructural observations of the capsule of chronic subdural hematoma. J Neurosurg 1975; 43:569-578.
15. Scotti G, Terbrugge K, Melançon D, Bélanger G. Evaluation of the age of subdural hematomas by computerized tomography. J Neurosurg 1977; 47:311-315.
16. Tabaddor K, Shulman K. Definitive treatment of chronic subdural hematoma by twist-drill craniostomy and closed-system drainage. J Neurosurg 1977; 46:220-226.
17. 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 1980; 52:776-781.
18. Weisse A, Berney J. Chronic subdural haematomas results of a closed drainage method in adults. Acta Neurochir ( Wien ) 1994; 127:37-40.
19. Yamashima T, Yamamoto S, Friede RL. The role of endothelial gap in the junctions in the enlargement of chronic subdural hematomas. J Neurosurg 1983; 59:298-303.

Hematoma subdural crônico: análise de 35 casos

Chronic subdural hematoma: analysis of 35 cases

Datas de Publicação

Publicação nesta coleção
07 Dez 2010
Data do Fascículo
Mar 1996

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

[1] 1. Bender MB, Christoff N. Non surgical treatment of subdural hematomas. Arch Neurol 1974, 31:73-79.

[2] 2. Benzei EC, Bridges RM, Hadden TA, Orrison WW. The single burr hole technique for the evacuation of non-acute subdural hematomas. Trauma 1994, 36:190-194.

[3] 3. Cameron MM. Chronic subdural hematoma: a review of 114 cases. J Neurol. Neurosurg Psychiatry 1978; 41:834-839.

[4] 4. Choudhuty AR. Avoidable factors that contribute to complications in the surgical treatment of chronic subdural haematoma. Acta Neurochir (Wien) 1994; 129:15-19.

[5] 5. Grisoli F, Graziani N, Peragut JC, Vincentelli F, Fabrizi AP, Caruso G, Bellard S. Perioperative lumbar injection of Ringer's lactate solution in chronic subdural hematomas: a series of 100 cases. Neurosurgery 1988; 23:616-621

[6] 6. Harden; A, Eggert HR, Weigel. Behandlung des chronischen Subduralhaematoms mit externer Geschlossener drainege. Neurochirurgia (Stuttg) 1982, 25:147-152.

[7] 7. Hill NC, Goldestein NP, Mckenziel BF. Cérebro spinal fluid proteins, glycoproteins and lipoproteins in obstructive lesions of the cental nervous system. Brain 1959; 82:581-593.

[8] 8. Hosoda K, Norihiko T, Masumura M, Matsumoto S, Maeda F. Magnetic resonance images of chronic subdural hematomas. J Neurosurg 1987; 67:677-683

[9] 9. Loew F, Kivelitz R. Chronic subdural hematomas. In Vinken PF, Bruyn GW (eds). Handbook of Clinical Neurology. New York: Elsevier, 1976, Vol 24, pt II.

[10] 10. Markwalder TM. Chronic subdural hematomas: a review. J Neurosurg 1981; 54:637 o45.

[11] 11. Markwalder TM, Reulen HJ. Influence of neomembranes organisation, cortical expansion and subdural pressure on the post-operative course of chronic subdural haematoma: an analysis f 201 cases. Acta Neurochir ( Wien ) 1986; 79:100-106.

[12] 12. Robinson RG. Chronic subdural hematoma: surgical management in 133 patients. J Neuros rg 1984; 61:263-268.

[13] 13. Rychlicki F, Recchioni MA, Burchianti M, Marcolini P, Messori A, Papo I. Per rutaneous twist-drill craniostomy for the treatment of chronic subdural haematoma. Acta Neurochir ( Wien ) 1991; 113:38-41.

[14] 14. Sato S, Suzuky J. Ultrastructural observations of the capsule of chronic subdural hematoma. J Neurosurg 1975; 43:569-578.

[15] 15. Scotti G, Terbrugge K, Melançon D, Bélanger G. Evaluation of the age of subdural hematomas by computerized tomography. J Neurosurg 1977; 47:311-315.

[16] 16. Tabaddor K, Shulman K. Definitive treatment of chronic subdural hematoma by twist-drill craniostomy and closed-system drainage. J Neurosurg 1977; 46:220-226.

[17] 17. 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 1980; 52:776-781.

[18] 18. Weisse A, Berney J. Chronic subdural haematomas results of a closed drainage method in adults. Acta Neurochir ( Wien ) 1994; 127:37-40.

[19] 19. Yamashima T, Yamamoto S, Friede RL. The role of endothelial gap in the junctions in the enlargement of chronic subdural hematomas. J Neurosurg 1983; 59:298-303.