CHRONIC SUBDURAL HEMATOMAS:COMPARATIVE CLINCAL AND ELECTROENCEPHALOGRAPHIC STUDIES ON THE RESULTS OF OPERATIONS THROUGH CRANIOTOMY AND TREPANATION
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Preoperative and postoperative clinical features and electroencephalographic findings in 128 cases with chronic subdural hematoma which were admitted to the Neurosurgical Clinic, the Gunma University Hospital in a period of 19 years, were studied. In 73 cases treated before 1967, total removal of the hematoma including the hematoma capsule was performed through osteoplastic craniotomy. In the remaining 54 cases treated later than 1968, evacuation and irrigation of the hematoma was performed through trepanation and the capsule was left behind.<BR>Preoperative clinical findings manifested by 128 cases were summarized as follows : 1) Signs and symptoms of chronic intracranial hypertension, 2) mental and psychiatric deficits, 3) focal signs indicating a lesion in the cerebral hemisphere, and 4) less frequently, in the brain stem and cerebellum. Preoperative electroencephalographies revealed 85% of the cases to be abnormal, and a multi-form slow wave focus was considered to be a definite localizing value for a hematoma.<BR>Early operative complications were observed in 16 cases (23%) of craniotomy-treated group as follows : re-retention of clot (3 cases), epidural hematoma (2), seizures (3), aphasia (2), wound infection (1), hallucination (1), and serum hepatitis (4). Those in the trepanation-treated group were observed in 4 cases (7%) : Injuries to the cerebral cortex (1) and cortical vein (1), wound infection (1), and hallucination (1). There was no operative death in either groups.<BR>Long-term follow-up results revealed that 97% of the cases of both groups had returned to normal life, while 41% of the craniotomy-treated group and 42% of the trepanation-treated group had some of either subjective complaints of neurological abnormalities. During the follow-up period over 19 years, eight patients died from other illnesses ; and no patient had a recurrence of the hematoma, but two were again treated for another chronic subdural hematoma on the opposite side, 5 and 10 years after the operation, respectively. These findings suggested that the persistent capsule in the trepanation-treated group would not be harmful to the postoperative course.<BR>Electroencephalographic examinations were performed in 83 cases of both groups at the time of the follow-up and revealed 16% of the craniotomy-treated group and 15% of the trepanation-treated group to be normal. Characteristic fast waves, with amplitude ranging from 10 to 40μV and frequency ranging from 18 to 30 Hz, were found in 58% of the craniotomy-treated group and 51% of the trepanation-treated group. They were usually observed over the frontal and central regions on the affected side, constantly or transiently, when awake with eyes closed or under hypnosis. But they did not appeared in the postoperative stage earlier than a week, but continued to appear, in some cases, 16 years after the operation, and not associated with any anti-epileptogenic drugs. In some cases, other activity of 11-14 Hz, resembling wicket rhythm (rythm en arceau), was also observed in the central region of the affected side. Though never proven, it was suggested that the longstanding compression by the hematoma might be a causative factor of the fast waves. Clinical seizures were observed only in one case of the trepanation-treated group, in which the fast wave showed a high amplitude over 100μV. Spike and wave complexes and slow wave foci were observed in 1 case of the craniotomy-treated and 3 of the trepanation-treateted group. Late epilepsies were reported to manifest in 3 and 2 cases of each group, respectively. It was considered unnecessary to give anticonvulsants in the postoperative course of a chronic subdural hematoma unless continuous electroencephalograshic examinations showed such overt abnormalities as spike and wave complexes and slow wave foci, or clinically evident seizures.
- 北関東医学会の論文
北関東医学会 | 論文
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