脑外伤合并小脑幕切迹疝术中复位的体会

目的探讨脑外伤合并小脑幕切迹疝手术中采用不切开小脑幕、直视下进行脑疝复位的临床疗效。方法回顾性分析68例额颞(顶)部开颅颅内血肿及脑挫裂伤合并脑疝患者,在常规开颅手术中注重精细操作,清除血肿、挫裂伤灶及廓清蛛网膜、脑池出血后,在保持小脑幕结构完整的前提下,进一步在镜下直视复位脑疝组织;并与同期另一组术中额颞部开颅但未行脑疝复位的116例患者进行术后CT、神志改善、瞳孔恢复、颅内压情况及脑梗死、脑积水并发症等比较。结果采用直视下脑疝组织复位术式的病例组,其术后CT特征、神志改善、瞳孔恢复等临床疗效均优于常规手术组。结论采用术中直视下复位治疗部分脑外伤合并小脑幕切迹疝可取得一定疗效。

Intraoperative reversal of transtentorial herniation with traumatic brain injury: clinical experience

A preliminary study on the intraoperative reversal of transtentorial herniation with traumatic brain injuryAbstract objective To explore the advantages of the directive reversal of transtentorial herniation without incising tentorium of cerebellum in the operation on traumatic brain injury. Methods One hundred eighty-four cases of traumatic brain injuries with transtentorial herniation were collected. All the cases were operated by transfrontal-temporal-parietal approach. The cerebral hemorrhage and the focuses of contusion and laceration were cleared thoroughly. Additionally, a group of 68 cases of transtentorial herniation were reversed directly under microscope, keeping the tentorium of cerebellum contact in the surgery. The computed tomography appearance, the improvement of mind and mydriasis, intracranial pressure and surgical complications such as brain infarction, hydrocephalus were compared between the two group postoperatively. Results The statistic result indicates that the computed tomography appearances, the improvement of mind and mydriasis, intracranial pressure and surgical complications of the group of intraoperative reversal is superior to the group of non-reversal. Conclusion The directive reversal of transtentorial herniation without incising tentorium of cerebellum in the operation on traumatic brain injury is superior to the control group. Keywords Traumatic brain injury; transtentorial herniation; operation; reservalappearance, the improvement of mind and mydriasis, intracranial pressure and surgical complications such as brain infarction, hydrocephalus were compared between the two group postoperatively. Results The statistic result indicates that the computed tomography appearances, the improvement of mind and mydriasis, intracranial pressure and surgical complications of the group of intraoperative reversal is superior to the group of non-reversal. Conclusion The directive reversal of transtentorial herniation without incising tentorium of cerebellum in the operation on traumatic brain injury is superior to the control group.