緊急穿頭術を施行した急性硬膜下血腫重症例の治療成績

<p>In this study, we reviewed the results of treatment in patients with acute subdural hematoma (ASDH) who underwent emergency burr hole surgery in the emergency center, and investigated factors involved in the outcome. The subjects were 108 patients with ASDH who underwent surgery between January 1996 and October 2004, with a Glasgow coma scale (GCS) score of 8 or lower. They were divided into 2 groups: patients who underwent emergency burr hole surgery in the emergency center, and patients who underwent elective craniotomy. We assigned 17 patients who underwent craniotomy after emergency burr hole surgery (16%) to Group A (burr hole surgery + craniotomy), 47 patients who underwent emergency burr hole surgery alone (43%) to Group B (burr hole surgery alone), and 44 patients who underwent elective craniotomy (41%) to Group C (craniotomy alone). In these patients, we investigated age, GCS score at arrival, interval until surgery, mechanism of injury, CT findings, injury severity score (ISS), presence or absence of reflex to light, presence or absence of shock, and treatment results, and analyzed the correlation between technique and each parameter. Subsequently, patients with a good outcome were compared to those with a poor outcome with respect to each factor. The outcome was evaluated based on Glasgow outcome scale (GOS) scores on discharge; patients with good recovery (GR) or moderate disability (MD) were regarded as achieving a favorable outcome, and those with severe disability (SD), vegetative state (VS), or who were dead (D) were regarded as achieving a poor outcome. Of the patients who underwent emergency burr hole surgery (Group A + Group B), 10 (16%) showed good outcomes. The survival rate was 31%. Good outcomes were achieved in 7 patients (41%) in Group A, in 3 patients (6%) in Group B, and in 14 patients (33%) in Group C. The survival rates were 76%, 15%, and 61% in Groups A, B, and C, respectively. Concerning technique, the proportion of patients aged more than 70 years, the proportion of patients with a GCS score of 4 or lower, the proportion of patients with the disappearance of reflex to light, and the incidence of shock in Group B were significantly higher than the values in Group C. In Group A, the number of patients in whom the interval from arrival until the start of surgery was 30 minutes or less was significantly larger than that in Group B. Five factors influenced the outcome: age (patients aged more than 60 years showed poor outcomes), GCS score at arrival (patients with a GCS score of 6 or lower showed poor outcomes) mechanism of injury (patients who were injured in a traffic accident showed poor outcomes), reflex to light (patients with the disappearance of reflex to light showed poor outcomes), and CT findings (patients with t-SAH showed poor outcomes).</p>