目的探讨脑池造瘘术联合标准去大骨瓣减压手术治疗颅高压患者的临床疗效。方法纳入河南省人民医院神经外科2018-12—2021-04收治的符合纳入标准和排除标准的颅高压患者。颅高压原因:自发性脑出血26例,脑梗死10例,外伤性脑损伤24例。采...目的探讨脑池造瘘术联合标准去大骨瓣减压手术治疗颅高压患者的临床疗效。方法纳入河南省人民医院神经外科2018-12—2021-04收治的符合纳入标准和排除标准的颅高压患者。颅高压原因:自发性脑出血26例,脑梗死10例,外伤性脑损伤24例。采用随机分组方式,造瘘组30例在原有标准去大骨瓣减压手术基础上加行脑池造瘘术,对照组30例行标准大骨瓣减压手术。比较2组患者手术时间、术后机械通气时间、总住院时间、ICU住院时间、脱水药物应用、病死率、随访6个月后的GOS-E评分。结果造瘘组术后脱水药物应用量[7375.00(5881.50~13310.00)mL vs 9950.00(8800.00~12812.50)m L]、机械通气时间[155.00(46.00~295.50)min vs 252.50(194.00~499.00)min]、ICU住院时间[18.00(10.50~23.00)d vs 23.50(16.50~30.00)d]均低于对照组(P<0.05),手术时间明显长于对照组[245.00(210.00~275.00)min vs 202.50(150.00~240.00)min]。2组患者术后总住院时间[22.00(18.50~29.50)d vs 31.50(25.50~38.25)d]、病死率(30.00%vs 40.00%)比较差异无统计学意义(P>0.05)。造瘘组患者术后6个月时GOS-E评分明显优于对照组(P<0.05),达到基本可以在家独立生活及以上。结论脑池造瘘术并标准去大骨瓣减压手术与单纯标准去大骨瓣减压术相比,在颅高压患者中可有效控制颅内压力,缩短ICU住院时间,明显改善患者的治疗效果,产生了长期的良性结果。展开更多
Introduction: Acute post traumatic subdural hematoma is a clinical condition with increased morbidity and mortality despite the developments in neurosurgery and urgent intervention is required to have best clinical ou...Introduction: Acute post traumatic subdural hematoma is a clinical condition with increased morbidity and mortality despite the developments in neurosurgery and urgent intervention is required to have best clinical outcome. We will evaluate hinged craniotomy technique in terms of offering adequate brain decompression plus avoiding removal of bone flap which requires second replacement surgery in comparison to cisternostomy effect. Material and Methods: A prospective study was conducted over 30 patients with traumatic acute subdural hematoma presented to neurotrauma unit in Cairo University hospitals from January 2017 to February 2018, operated by hinged craniotomy plus evacuation of hematoma and duroplasty. We avoid rapping the head with elastic bandage post-operative. Generous subcutaneous dissection (5 - 7 cm) all around skin flap was done routinely. Effect of brain decompression was evaluated by measuring the level of brain in relation to skull in post-operative computerized topography. Results: Twenty-one patients operated with initial GCS less than eight. Ten cases (33%) show that cortical surface in relation to skull bone was at inner table, nine cases (30%) at diploid layer and two cases (6.7%) at outer table in post-operative CT brain. Twenty patients died (66.7%);eight patients (26.6%) became fully conscious and two patients (6.7%) had vegetative outcome. No re-operation was done in any of our patients. Conclusion: Hinged craniotomy may be a safe and effective alternative technique with comparable results to cisternotomy in cases of traumatic brain injury that require decompression to avoid second surgery, especially in centres lacking cisternostomy experience. Although gaining cisternostomy experience may help in other indications, future prospective studies with larger number are required.展开更多
In subarachnoid hemorrhage following traumatic brain injury (TBI), the high intracisternal pressure drives the cerebrospinal fluid into the brain parenchyma, causing cerebral edema. Basal cisternostomy involves openin...In subarachnoid hemorrhage following traumatic brain injury (TBI), the high intracisternal pressure drives the cerebrospinal fluid into the brain parenchyma, causing cerebral edema. Basal cisternostomy involves opening the basal cisterns to atmospheric pressure and draining cerebrospinal fluid in an attempt to reverse the edema. We describe a case of basal cisternostomy combined with decompressive craniectomy. A 35-year-old man with severe TBI following a road vehicle accident presented with acute subdural hematoma, Glasgow coma scale score of 6, fixed pupils and no corneal response. Opening of the basal cisterns and placement of a temporary cisternal drain led to immediate relaxation of the brain. The patient had a Glasgow coma scale score of 15 on postoperative day 6 and was discharged on day 10. We think basal cisternostomy is a feasible and effective procedure that should be considered in the management of TBI.展开更多
文摘目的探讨脑池造瘘术联合标准去大骨瓣减压手术治疗颅高压患者的临床疗效。方法纳入河南省人民医院神经外科2018-12—2021-04收治的符合纳入标准和排除标准的颅高压患者。颅高压原因:自发性脑出血26例,脑梗死10例,外伤性脑损伤24例。采用随机分组方式,造瘘组30例在原有标准去大骨瓣减压手术基础上加行脑池造瘘术,对照组30例行标准大骨瓣减压手术。比较2组患者手术时间、术后机械通气时间、总住院时间、ICU住院时间、脱水药物应用、病死率、随访6个月后的GOS-E评分。结果造瘘组术后脱水药物应用量[7375.00(5881.50~13310.00)mL vs 9950.00(8800.00~12812.50)m L]、机械通气时间[155.00(46.00~295.50)min vs 252.50(194.00~499.00)min]、ICU住院时间[18.00(10.50~23.00)d vs 23.50(16.50~30.00)d]均低于对照组(P<0.05),手术时间明显长于对照组[245.00(210.00~275.00)min vs 202.50(150.00~240.00)min]。2组患者术后总住院时间[22.00(18.50~29.50)d vs 31.50(25.50~38.25)d]、病死率(30.00%vs 40.00%)比较差异无统计学意义(P>0.05)。造瘘组患者术后6个月时GOS-E评分明显优于对照组(P<0.05),达到基本可以在家独立生活及以上。结论脑池造瘘术并标准去大骨瓣减压手术与单纯标准去大骨瓣减压术相比,在颅高压患者中可有效控制颅内压力,缩短ICU住院时间,明显改善患者的治疗效果,产生了长期的良性结果。
文摘Introduction: Acute post traumatic subdural hematoma is a clinical condition with increased morbidity and mortality despite the developments in neurosurgery and urgent intervention is required to have best clinical outcome. We will evaluate hinged craniotomy technique in terms of offering adequate brain decompression plus avoiding removal of bone flap which requires second replacement surgery in comparison to cisternostomy effect. Material and Methods: A prospective study was conducted over 30 patients with traumatic acute subdural hematoma presented to neurotrauma unit in Cairo University hospitals from January 2017 to February 2018, operated by hinged craniotomy plus evacuation of hematoma and duroplasty. We avoid rapping the head with elastic bandage post-operative. Generous subcutaneous dissection (5 - 7 cm) all around skin flap was done routinely. Effect of brain decompression was evaluated by measuring the level of brain in relation to skull in post-operative computerized topography. Results: Twenty-one patients operated with initial GCS less than eight. Ten cases (33%) show that cortical surface in relation to skull bone was at inner table, nine cases (30%) at diploid layer and two cases (6.7%) at outer table in post-operative CT brain. Twenty patients died (66.7%);eight patients (26.6%) became fully conscious and two patients (6.7%) had vegetative outcome. No re-operation was done in any of our patients. Conclusion: Hinged craniotomy may be a safe and effective alternative technique with comparable results to cisternotomy in cases of traumatic brain injury that require decompression to avoid second surgery, especially in centres lacking cisternostomy experience. Although gaining cisternostomy experience may help in other indications, future prospective studies with larger number are required.
文摘In subarachnoid hemorrhage following traumatic brain injury (TBI), the high intracisternal pressure drives the cerebrospinal fluid into the brain parenchyma, causing cerebral edema. Basal cisternostomy involves opening the basal cisterns to atmospheric pressure and draining cerebrospinal fluid in an attempt to reverse the edema. We describe a case of basal cisternostomy combined with decompressive craniectomy. A 35-year-old man with severe TBI following a road vehicle accident presented with acute subdural hematoma, Glasgow coma scale score of 6, fixed pupils and no corneal response. Opening of the basal cisterns and placement of a temporary cisternal drain led to immediate relaxation of the brain. The patient had a Glasgow coma scale score of 15 on postoperative day 6 and was discharged on day 10. We think basal cisternostomy is a feasible and effective procedure that should be considered in the management of TBI.
