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首页> 外文期刊>Journal of neurosurgery. Pediatrics. >Postoperative epidural hematoma covering the galeal flap in pediatric patients with moyamoya disease: Clinical manifestation, risk factors, and outcomes - Clinical article
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Postoperative epidural hematoma covering the galeal flap in pediatric patients with moyamoya disease: Clinical manifestation, risk factors, and outcomes - Clinical article

机译：小儿烟雾病患者术后覆盖硬膜外皮的硬膜外血肿：临床表现，危险因素和预后-临床文章

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Object. Postoperative epidural hematoma (EDH), a blood collection between the inserted galeal flap and the overlying skull flap (epigaleal flap hematoma), is a frustrating complication of the surgical treatment of moyamoya disease (MMD) in pediatric patients. The symptoms of postoperative EDH are often similar to those of postoperative cerebral ischemia, and may cause confusion during clinical decision making. The authors designed this study to evaluate the incidence, clinical presentation, risk factors, and treatment outcomes of postoperative EDH in pediatric patients with MMD. Methods. A retrospective review of 148 pediatric patients with 250 craniotomies who underwent indirect bypass revascularization surgery between January 2002 and December 2006 was performed. This group consisted of 60 male and 88 female patients, and the mean age at surgery was 7.5 years (range 1-18 years). Results. Of the 250 craniotomies, postoperative EDH was detected in 32 cases. In 12 cases of EDH, surgical treatment was necessary (4.8% of 250 craniotomies). During the same period, 743 non-MMD craniotomy operations were performed. In 6 of these 743 operations, patients developed postoperative EDH that required surgical treatment, significantly less than the percentage of EDH requiring postoperative treatment in patients with MMD (0.8%, p < 0.001). The average interval between craniotomy surgery and the detection of EDH was 1.8 days (range 0-5 days) in patients with MMD and 0.5 days (range 0-2 days; p = 0.018) in the non-MMD craniotomy group. Postoperative EDH was observed in significantly fewer cases (17 of 191) when a subcutaneous drain (SCD) was inserted over the bone flap than in cases in which an SCD was not inserted (14 of 55; p = 0.001). The mean international normalized ratio of prothrombin time in the immediate postoperative blood test was 1.27 ± 0.17 in the EDH group and 1.20 ± 0.11 in the non-EDH group (values are expressed as the mean ± SD; p = 0.008). Central galeal flap tenting suture and immediate postoperative platelet count were not related to the incidence of postoperative EDH following pediatric MMD surgery. Conclusions. Postoperative EDH is more likely to be found following craniotomy in patients with MMD than in those without MMD, and may occur in a delayed fashion. Insertion of an SCD and immediate correction of an abnormal value for international normalized ratio of prothrombin time can decrease the incidence of postoperative EDH following surgery for pediatric MMD.
机译：目的。术后硬膜外血肿（EDH）是在插入的galeal皮瓣和上面的颅骨皮瓣（上睑皮瓣血肿）之间收集的血液，是小儿患者烟雾病（MMD）外科治疗的令人沮丧的并发症。术后EDH的症状通常类似于术后脑缺血的症状，并可能在临床决策过程中引起混乱。作者设计了这项研究，以评估MMD患儿术后EDH的发生率，临床表现，危险因素和治疗结果。方法。回顾性分析了2002年1月至2006年12月间接受间接旁路血运重建术的148例小儿患者的250例开颅手术。该组由60位男性和88位女性组成，平均手术年龄为7.5岁（1-18岁）。结果。在250例开颅手术中，有32例术后EDH被检测到。在12例EDH病例中，必须进行手术治疗（250例开颅手术中占4.8％）。在同一时期，进行了743次非MMD开颅手术。在这743例手术中，有6例患者发生了需要手术治疗的术后EDH，远低于MMD患者需要术后治疗的EDH百分比（0.8％，p <0.001）。 MMD患者开颅手术与EDH检测之间的平均间隔为1.8天（范围为0-5天），非MMD开颅手术组的平均间隔为0.5天（范围为0-2天; p = 0.018）。与未插入SCD的情况相比，在皮瓣上方插入皮下引流（SCD）的情况下观察到的术后EDH显着更少（191例中的17例）（55例中的14例; p = 0.001）。术后即刻血液检查中，凝血酶原时间的国际标准化平均比率在EDH组为1.27±0.17，在非EDH组为1.20±0.11（值表示为平均值±SD; p = 0.008）。小儿MMD手术后中央gal瓣皮瓣帐篷缝合和术后立即血小板计数与术后EDH的发生率无关。结论。 MMD患者开颅术后比非MMD患者更容易发现术后EDH，并且可能以延迟的方式发生。插入SCD并立即纠正凝血酶原时间的国际标准化比率的异常值可降低小儿MMD手术后EDH的发生率。

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