目的 探讨慢性硬膜下血肿（chronic subdural hematoma, CSDH）位置与枕部颅骨形态的关系。方法 对98例经历CSDH手术患者的头颅CT/MRI影像进行回顾，对颅骨的对称性和CSDH的位置进行分析。结果 患者平均（71.00±13.96）岁 (37～93岁)。枕部颅骨对称患者37例，不对称61例。在不对称颅骨扁平位于右侧的有41例，位于左侧的有20例。CSDH为双侧患者20例，单侧78例，单侧血肿中30例位于右侧，48例位于左侧。双侧CSDH在枕部颅骨对称者较不对称者更为普遍，差异具有统计学意义(P=0.021)。在61例枕部颅骨不对称者中，CSDH双侧8例，在其余的53例患者中，CSDH位于枕部颅骨扁平对侧的有37例，而位于扁平同侧的有16例。结论 双侧CSDH常发生在枕部颅骨对称的患者，而在枕部颅骨不对称的患者，CSDH通常位于枕部颅骨扁平侧的对侧。
Abstract
Objective To evaluate the relationship between occipital cranial morphology and location of chronic subdural hematoma (CSDH). Methods The computed tomographic scans (CT) or magnetic resonance images(MRI) of 98 consecutive patients who underwent surgery for CSDH in the Air Force General Hospital of PLA between January 2002 and April 2012 were re-evaluated, and the symmetry of the occipital cranial vault, and the location of the CSDH were all checked. Results The mean age of the patients was 71.00?13.96 years (age range, 37-93 years).The occipital cranial vault was symmetrical in 37 patients (37.8%) and asymmetrical in 61 patients (62.2%).The asymmetric crania were flat on the right side in 41 patients, on the left side in 20 patients. CSDH was bilateral in 20 patients (20.4%) and unilateral in 78 patients (79.6%), and the unilateral hematomas were located on the right side in 30 patients and on the left side in 48 patients. It was more commonly bilateral in patients with a symmetrical occipital skull vault than those with an asymmetrical one and this difference was statistically significant (P=0.021). In 61 patients with an asymmetric occipital cranial vault, the CSDH was bilateral in 8 patients. In the remaining 53 patients, the CSDH located on the opposite side of the flat side in 37 patients, and located on the same side of the flat side in 16 patients. Conclusions Bilateral CSDH is common in patients with symmetrical occipital cranial vault. In asymmetrical occipital cranial vault, CSDH is usually located on the opposite to the flat side of the skull.
关键词
慢性硬膜下血肿 /
颅骨形态学 /
颅顶 /
计算机断层扫描 /
硬膜边缘细胞
Key words
chronic subdural hematoma /
cranial morphology /
cranial vault /
computed tomography；dural border cell
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
［1］ Weigel R, Schmiedek P, Krauss J K. Outcome of contemporary surgery for chronic subdural haematoma: evidence based review ［J］. J Neurol Neurosurg Psychiatry, 2003, 74(7): 937-943.
［2］ Santarius T, Kirkpatrick P J, Ganesan D, et al. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial ［J］. Lancet, 2009, 374 (9695): 1067-1073.
［3］ Kim B G, Lee K S, Shim J J, et al. What determines the laterality of the chronic subdural hematoma？［J］. J Korean Neurosurg Soc, 2010, 47(6): 424-427.
［4］ Akhaddar A, Bensghir M, Elmoustarchid B, et al. Influence of cranial morphology on the location of chronic subdural haematoma ［J］. Acta Neurochir (Wien), 2009, 151(10): 1235-1240.
［5］ MacFarlane M R, Weerakkody Y, Kathiravel Y. Chronic subdural haematomas are more common on the left than on the right ［J］. J Clin Neurosci, 2009, 16(5): 642-644.
［6］ Lee K S, Bae W K, Yoon S M, et al. Location of the chronic subdural haematoma: role of the gravity and cranial morphology ［J］. Brain Inj, 2001, 15(1): 47-52.
［7］ Haines D E, Harkey H L, Mefty O. The "subdural" space: a new look at an outdated concept ［J］. Neurosurgery, 1993, 32(1): 111-120.
［8］ Sato S, Suzuki J. Ultrastructural observations of the capsule of chronic subdural hematoma in various clinical stages ［J］. J Neurosurg, 1975, 43(5): 569-578.
［9］ Orlin J R, Osen K K, Hovig T. Subdural compartment in pig: a morphologic study with blood and horseradish peroxidase infused subdurally ［J］. Anat Rec, 1991, 230(1): 22-37.
［10］ Mack J, Squier W, Eastman J T. Anatomy and development of the meninges: implications for subdural collections and CSF circulation ［J］. Pediatr Radiol, 2009,39(3): 200-210.
［11］ Lee K S. Natural history of chronic subdural haematoma ［J］. Brain Inj, 2004, 18(4): 351-358.
［12］ Lee K S, Doh J W, Bae H G, et al.Relations among traumatic subdural lesions ［J］.J Korean Med Sci, 1996, 11(1): 55-63.
［13］ Park S H, Lee S H, Park J, et al. Chronic subdural hematoma preceded by traumatic subdural hygroma ［J］. J Clin Neurosci, 2008, 15(8): 868-872.
［14］ Ozdemir N, Ari M K, Gelal M F, et al. Intracranial chronic subdural haematoma as a complication of epidural anesthesia ［J］. Turk Neurosurg, 2009, 19(3): 285-287.
［15］ Su T M, Lee T H, Huang Y H,et al. Contralateral subdural effusion after decompressive craniectomy in patients with severe traumatic brain injury: clinical features and outcome ［J］. J Trauma,2011,71(4): 833-837.
［16］ Kovalev V A, Kruggel F, Von Cramon D Y. Gender and age effects in structural brain asymmetry as measured by MRI texture analysis ［J］. Neuroimage, 2003, 19(3): 895-905.
［17］ Hervé P Y, Crivello F, Perchey G, et al. Handedness and cerebral anatomical asymmetries in young adult males ［J］. Neuroimage, 2006, 29(4): 1066-1079.
［18］ Thambisetty M, Wan J, Carass A, et al. Longitudinal changes in cortical thickness associated with normal aging ［J］. Neuroimage, 2010, 52(4): 1215-1223.
［19］ 张宝国，尹 震，马宏伟，等. 改进法闭式引流治疗慢性硬膜下血肿的疗效分析［J］.武警医学，2008, 19(11): 987-990.
［20］ Abouzari M, Rashidi A, Rezaii J, et al. The role of postoperative patient posture in the recurrence of traumatic chronic subdural hematoma after burr-hole surgery ［J］. Neurosurgery, 2007, 61(4): 794-797.[ZK)]
(2012-06-21
PDF(654 KB)
