重型特重型颅脑伤脑疝时应用天幕裂孔切开术的临床研究(附89例报告)

目的 探索开幕裂孔切开术在救治重型特重型颅脑伤合并颞叶钩回疝的作用。方法 对我科1994年7月到2000年12月间收治的89例重型特重型颅脑伤合并有颞叶钩回疝继发脑干伤患者在开颅清除血肿去骨瓣的基础上加行天幕裂孔切开术。结果 GCS 3-5分32例,6-8分57例,恢复良好48例(53.9％),中残13例(14.6％),重残9例(10.1％),植物生存7例(7.8％),死亡12例(13.5％)。结论 天幕裂孔切开术有利于缓解颞叶钩回疝及所致继发性脑干伤,降低病残率和死亡率。

Clinical study of tentorium cerebelli hiatus incision in the treatment of severe and most severe brain injury complicated by tentorial herniation (A report of 89 cases)

Objectives To explore the effect of tentorium cerebelli hiatus incision in the treatment of severe and most severe brain injury complicated by tentorial herniation. Methods Tentorium cerebelli hiatus incision was made following intracranial hematoma evacuation and bone flap craniotectomy decompression done on 89 patients of severe and most severe brain injury with secondary brain stem injury complicated by tentorial hernia- tion from July 1994 to Dec 2000. Results Thirty two cases were classified in GCS score 3-5; 57 cases, GCS score 6-8. 48 cases (53. 9%) were survived in good condition, 13 cases (14. 6%) had moderate disability, 9 cases (10. 1%) had severe neurological dysfunction, 7cases (7. 8%) were vegetative and 12 cases (13. 5%) were dead. Conclusions Approaching from tentorium cerebelli hiatus incision is effective in reducing secondary brain stem injury resulting from tentorial herniation and can bring down the rate of disability and mortality for these critical patients.