摘要
目的探讨特重型颅脑损伤患者手术中发生急性脑膨出的防治措施。方法采用扩大额颞顶开颅去骨瓣减压术治疗19例特重型颅脑损伤,术中均采取顺序硬脑膜切开法分次切开硬脑膜。对此19例病例临床资料进行了回顾性分析。结果所有病例术中均未出现难以控制的脑膨出。术后复查头颅CT显示,血肿基本清除12例,血肿仍大片存在4例,其它部位继发血肿3例;环池、基底池、第三脑室复现12例,无明显变化7例。出院时行GOS预后评定:良好1例,中残1例,重残2例,植物生存4例,死亡11例(死亡率57.9%)。结论特重型颅脑损伤患者颅内压高,术中减压过快容易出现急性脑膨出,采用"尽早减压、逐步减压"和顺序硬脑膜切开法能明显降低术中急性脑膨出发生率,降低残死率。
Objective To explore the measures to prevent acute encephalocele during the decompessive craniotomy in the patients with especially severe brain injury. Methods The clinical data of 19 patients with especially severe brain injury, who were treated by extended fronto-temporo-prietal craniotomy in our department from January, 2005 to December, 2006, were analyzed retrospectively. The sequential dural incision （SDI） was performed during the operation in all the patients. Results The catastrophic encephalocele did not occur in all the cases even if very high intracranial pressure was caused by fulminant brain swelling in some cases. The total removal of hematomas was achieved in 12 cases, but there still was extensive hemorrhage in the operative field in 4 cases and secondary intracranial hematomas in the other regions in 3 cases observed on postoperative CT scan. The disappeared basal cistern and the thii＇d ventricle could be observed again in 12 cases and were unchanged in 7. According to GOS, 1 patient obtained good recovery, 1 was moderately disabled, 2 were severely disabled, 4 vegetatively survived, and 11 died. Conclusion The encephalocele, which is easily produced by rapid decompression, is prevented by controllable decompression as early as possible and SDI in the patients with especially severe brain injury.
出处
《中国临床神经外科杂志》
2008年第4期217-219,共3页
Chinese Journal of Clinical Neurosurgery
关键词
颅脑损伤
特重型
脑膨出
脑肿胀
减压术
Especially severe brain injury
Encephalocele
Brain swelling
Decompressive craniotomy
