双额叶脑挫裂伤早期手术治疗体会

目的探讨双额叶脑挫裂伤早期手术的疗效。方法回顾分析双额叶脑挫裂伤50例,6～8 h内及时行冠状切口双额骨瓣或扩大翼点额颞顶开颅,清除血块及碎裂失活脑组织,去除骨瓣减压。结果治愈40例,好转5例,死亡5例。结论双额叶脑挫裂伤应早期手术,行双侧冠状开颅或双额颞大骨瓣开颅充分减压,是救治成功的关键。     

大骨瓣减压治疗脑挫裂伤合并硬膜下血肿10例

我科应用大骨瓣减压治疗10例脑挫裂伤合并硬膜下血肿,均收到良好疗效,现将初浅体会报告如下。临床资料本组10例均因后枕部着力致脑的对冲性损伤,有中间清醒期。出现单侧瞳孔扩大者9例,双侧瞳孔扩大1例,偏瘫9例,去脑强直1例。10例病人均行血舯清除、大骨瓣减压术,其中9例存活,且生活自理;1例死于肺内感染。手术步骤:首先在瞳孔扩大侧的颞部钻孔探查,征实有血肿后扩大钻孔,切开硬脑膜放出部分积血,以暂时缓解脑压。然后延伸切口,做额顶颞部大于10×10cm的骨瓣,剪开硬脑膜,清除血肿,同时将额极、颞极已丧失生机的脑组织一并吸除,彻底止血。为使颞极暴露良好,应尽可能将颞骨咬除至颅底,既有利于解除脑疝,又有利于手术操作。将骨片去除后,不缝硬膜,严密缝合帽状腱膜及头皮。     

标准外伤大骨瓣开颅术治疗重型颅脑损伤

目的评价标准外伤大骨瓣开颅术(standard large traume craniotomy)对重型颅脑损伤的治疗效果。方法对38例重型颅脑损伤患者行标准外伤大骨瓣开颅术，清除血肿和去骨瓣减压。结果38例中，恢复良好21例，中残6例，重残3例，死亡8例，与同期34例行常规额颞项骨瓣开颅组比较，疗效有显著性差异。结论标准外伤大骨瓣开颅术适用于急性单侧幕上颅内血肿、脑挫裂伤以及单侧大脑半球肿胀，具有如下优点：(1)暴露广泛，术中急性脑膨出发生率低；(2)减压充分，脑疝易于复位；(3)可增加术中硬脑膜修补的机会。     

颅骨自体皮下埋藏保存后原位回植

1994年 11月～ 1997年 7月我院将原来开颅减压手术丢弃的颅骨瓣作自体皮下保存 ,3个月后取出作原位回植修复颅骨缺损 ,随访 30例 ,效果良好 ,均达骨性愈合。1　临床资料1 1　一般资料30例中男 17例 ,女 13例 ,年龄 2 2～ 5 9岁。去骨瓣减压原因均为脑挫裂伤、颅内血肿。颅骨缺损部位 :额、颞顶、额颞。骨瓣面积 30～ 12 0ｃｍ2 ,平均 (4 9 33± 17 2 5 )ｃｍ2 。1 2　自体保存方法在作开颅血肿清除减压术时 ,将游离骨瓣取下后 ,浸泡于生理盐水中 ,手术结束前 ,于左下腹作一斜切口 ,将游离骨瓣置于腹外斜肌腱膜浅面 ,凸面朝外。1 3　再植方法…     

骨膜为蒂的颞深筋膜瓣在标准外伤性大骨瓣开颅硬脑膜减张缝合中的应用研究

目的探讨骨膜为蒂的颞深筋膜瓣在标准外伤性大骨瓣开颅硬脑膜减张缝合中应用。方法分析研究重型颅脑损伤标准外伤性大骨瓣入路开颅的患者74例,分为人工脑膜组36例和骨膜为蒂的颞深筋膜组38例,2组均行开颅血肿清除术+去骨瓣减压术并减张缝合硬膜,观察术后的硬膜间积液等并发症和经济负担。结果骨膜为蒂的颞深筋膜组术后无并发症,经济负担轻,与对照组比较有统计学意义(P<0.01)。结论骨膜为蒂的颞深筋膜瓣在标准外伤性大骨瓣开颅硬脑膜减张缝合的手术操作方法可以安全应用,是对标准外伤性大骨瓣开颅术的重要补充。     

用自家颅骨骨瓣移植修复颅骨缺损13例报告

我院自1982年以来应用自家颅骨骨瓣移植修补外伤性颅骨缺损13例,17个部位。收到了满意临床效果,特报告如下。临床资料本组颅脑损伤特重型4例,重型9例。原因以交通肇事最多(占6/13),颅脑损伤以硬膜下血肿合并脑挫裂伤最多(占8/13)。该组患者均行钻孔探查、血肿清除、去骨瓣减压及内外减压术。其中单侧额颞骨瓣(大骨瓣)减压9例;单侧额颞骨瓣合并脑内(切除额颞叶极部)减压5例,双额颞骨瓣(大骨瓣)减压4例,双侧额颞骨瓣加脑内减压4例。     

创伤急性硬膜下血肿不同术式效果观察

目的 分析颅脑外伤所致急性硬膜下血肿患者接受急诊实施标准开颅血肿清除加去骨瓣减压术治疗的临床效果。方法 以2021年1月1日至2021年12月31日期间在本院接受急诊治疗的颅脑外伤所致急性硬膜下血肿患者72例为研究对象，将其凭借随机数字表法进行分组。观察组患者接受标准开颅血肿清除加去骨瓣减压术治疗，对照组患者接受血肿清除骨瓣回纳术治疗。对比术后颅内压减弱情况、手术安全性以及治疗效果。结果 术后1天、3天、1周的颅内压对比，观察组均低于对照组（P<0.05）；术后并发症发生率对比，为观察组更低（P<0.05）；术后治疗效果对比，为观察组更高（P<0.05）。结论 颅脑外伤所致急性硬膜下血肿患者接受急诊实施标准开颅血肿清除加去骨瓣减压术治疗取得了明显的治疗效果，患者颅内压明显降低，术后不良反应发生率较低，患者预后更佳。     

骨瓣开颅外侧裂蛛网膜撕裂治疗难治性硬膜下积液20例体会

目的探讨骨瓣开颅大脑外侧裂蛛网膜撕裂治疗外伤性难治性硬膜下积液的疗效。方法 20例外伤性难治性硬膜下积液患者均行骨瓣开颅大脑外侧裂蛛网膜撕裂术,术后随诊6个月,观察患者积液有无复发。结果本组20例经手术治疗积液完全消失,20例随诊无1例复发,有效率100%。结论骨瓣开颅外侧裂蛛网膜撕裂治疗难治性硬膜下积液疗效确切,有临床推广价值。     

人工脑膜在去骨瓣减压术中的应用分析

<正>重型颅脑损伤因各种原因引起高颅压,易发生脑疝危及生命,标准大骨瓣开颅血肿清除去骨瓣减压是目前常用的手术方式,过去常用颞肌和硬膜直接缝合以保持脑膜的完整性,但由于取材有限,缝合不够严密,术后易发生脑脊液漏,脑膨出,脑膜脑瘢痕与颞肌粘连易引起癫痫等并发症。本院自2008年2月起在去骨瓣减压术中行人工硬脑膜修补58例,取得了明显的疗效。现报道如下。     

额颞部对冲性脑损伤的临床特点与治疗分析

目的:探讨额颞部对冲性脑损伤的临床特点、手术指征、手术时机及手术方式。方法:回顾分析320例额颞部对冲性脑损伤的临床表现、影像学检查、手术指征、术后处理及预后。手术治疗260例,非手术治疗60例。手术采用改良翼点开颅血肿清除术,其中去骨瓣减压194例,骨瓣复位或漂浮复位66例。气管切开106例,亚低温治疗45例。结果:恢复良好225例,中残32例,重残15例,植物生存状态3例,死亡45例。结论:伤后进行性意识障碍,CT显示一侧或两侧额颞广泛脑挫伤并硬膜下血肿,持续较长时间脑水肿是其临床特点。伴有脑干损害时,意识障碍重,昏迷时间较长。弥漫性脑肿胀、脑室受压、环池闭塞者预后差。改良翼点开颅是理想的手术方式。大骨瓣减压联合亚低温治疗能显著提高重型额颞脑损伤抢救成功率。     

Acute subdural hematoma caused by mild head trauma in the aged]

We encountered 8 cases of acute subdural hematoma caused by mild head trauma in the aged. In this report, these cases were analyzed, taking into consideration clinical symptoms, CT scan, operative findings and outcome. The age ranged from 70 to 92 years (mean age of 79.7 years). 4 patients were male and 4 female. Head trauma was caused by falls in 4 patients, but in the other 4 patients the causes were unknown. Initial symptoms were headache, nausea and vomiting in 5 patients and mild disturbance of consciousness with lucid intervals in 3 patients. Seven patients had more than 100 on JCS and less than 9 on GCS on admission. Small craniotomy (HITT) was performed in 4 patients. Large craniotomy was performed in 2 patients, and decompressive craniectomy was carried out in 2 patients. The bleeding focus came from the cortical artery of the middle cerebral artery in 4 patients, cerebral contusion in 2 patients, and was unknown in 2 patients for HITT. CT scan on admission showed mixed density area of acute subdural hematoma in all of the patients, and intraventricular hemorrhage, intracerebral hemorrhage and subarachnoid hemorrhage in 3 patients. CT scan after operation revealed a new area of cerebral contusion in 3 patients, delayed traumatic intracerebral hematoma (DTICH) in 2 patients, and hypertensive intracerebral hemorrhage in 1 patient. Two patients recovered to good and fair without general complication. But the outcome in 5 patients with general complication was poor for 3 patients and fatal for 2 patients. In conclusion, large craniotomy is recommended because of bleeding from the cortical artery of the middle cerebral artery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Infantile acute subdural hematoma. Clinical analysis of 26 cases

Twenty-six cases of infantile acute subdural hematoma treated between 1972 and 1983 were reviewed. The series was limited to infants with acute subdural hematoma apparently due to minor head trauma without loss of consciousness, and not associated with cerebral contusion. Twenty-three of the patients were boys, and three were girls, showing a clear male predominance. The patients ranged in age between 3 and 13 months, with an average age of 8.1 months, the majority of patients being between 7 and 10 months old. Most of the patients were brought to the hospital because of generalized tonic convulsion which developed soon after minor head trauma, and all patients had retinal and preretinal hemorrhage. The cases were graded into mild, intermediate, and fulminant types, mainly on the basis of the level of consciousness and motor weakness. Treatment for fulminant cases was emergency craniotomy, and that for mild cases was subdural tapping alone. For intermediate cases, craniotomy or subdural tapping was selected according to the contents of the hematoma. The follow-up results included death in two cases, mild physical retardation in one case, and epilepsy in one case. The remaining 23 patients showed normal development. The relationship between computerized tomography (CT) findings and clinical grading was analyzed. Because some mild and intermediate cases could be missed on CT, the importance of noting the characteristic clinical course and of funduscopic examination is stressed.     

外伤性脑梗塞的临床治疗体会(附51例报告)

【摘要】〓目的〓探讨外伤性脑梗塞临床特点及预防、治疗方法。方法〓回顾分析51例外伤性脑梗塞患者的诊断、治疗方法及结果。结果〓34例患者行开颅血肿清除、挫裂伤病灶清除,其中22例患者行去骨瓣减压术,12例患者行内减压术。7例患者进行再次开颅清除血肿清除、减压术,死亡7例。全部诊断外伤性脑梗塞的患者均予扩容、改善循环、解痉、高压氧、激素及降低颅内压等治疗;明显蛛网膜下腔出血的患者予多次腰穿或腰大池持续引流等处理。随访2年,按GOS分级判断预后,良好22例,中残9例,重残7例,植物生存6例。结论〓颅脑外伤治疗过程中应注意外伤性脑梗塞发生和发展,早期诊断及治疗可能有利于降低脑梗患者的致残率。     

Acute spontaneous subdural hematoma of arterial origin

BACKGROUND: Acute subdural hematoma is usually associated with cerebral contusion or laceration of the bridging veins following a head injury. However, several cases of acute subdural hematoma without head injury (acute spontaneous subdural hematoma) have been reported. METHODS: Among 162 cases of acute subdural hematoma admitted to our departments between 1996 and 2003, we repoort eight cases of acute spontaneous subdural hematoma. These cases fulfilled the following criteria. 1) Head injury was either trivial or absent. 2) Neither aneurysm nor arteriovenous malformation was apparent. 3) CT scan revealed neither brain contusion nor traumatic subarachnoid hemorrhage. 4) At operation, laceration of the cortical artery was observed. In this article, we describe the clinical feature (age, sex, Glasgow Coma Scale [GCS] Score on admission, past history, CT appearance, and outcome) associated with this condition. RESULTS: Patients ranged in age from 68 to 85 years (average 74.8 years), and were comprised of 3 males and 5 females. Previous medical history included cerebral infarction in 6 of the 8 patients and myocardial infarction in 1 patient. These seven patients were taking antiplatelet manifestation. GCS on admission ranged from 4 to 13. Five of the 7 patients on antiplatelet medication had secondary insults, such as hypoxia. On CT, hematoma thickness ranged from 13.2mm to 42.5mm (average 22.6mm), and midline shift ranged from 10.0mm to 24.0mm (average 16.5mm). Neurological outcome evaluated using the Glasgow Outcome Scale was as follows, good recovery n = 2, moderate disability n = 2, severe disability n = 3, persistent vegetative state n = 1. CONCLUSION: The mechanism of acute spontaneous subdural hematoma is influenced by the presence of pre-existing cerebrovascular disease and by the use of antiplatelet agents. In such cases, the possibility of cortical arterial bleeding should be taken into account, and craniotomy should be performed.     

神经内镜下行基底节脑出血血肿清除术的临床体会

［摘要］ 目的 研究神经内镜下血肿清除术和传统开颅血肿清除术治疗基底节脑出血的临床疗效差异。方法 选取2017年01月01日至2018年08月31日期间我科收治的基底节脑出血患者作为研究对象,采用倾向性匹配原则分为开颅组和内镜组,分别为49例和53例,以保证两组患者病情的可比性。开颅组进行传统开颅血肿清除术,内镜组进行完全内镜下血肿清除术,然后比较两组患者的术中和术后相关信息、术后并发症差异、临床预后差异,以评价两种手术方式的优弊。结果 开颅组患者和内镜组患者在手术用时、血肿清楚率、再出血发生率上并无统计学差异（P>0.05）,但内镜组患者在术中出血量低于开颅组,术后2周、3个月时GCS评分要高于开颅组,差异有统计学意义（P<0.05）;开颅组和内镜组患者术后出现肺部感染、泌尿系感染、静脉血栓、消化道出血、术口感染、术后癫痫上无统计学差异（P>0.05）,但在术后脑水肿的发生率上内镜组低于开颅组,差异有统计学意义（P<0.05;内镜组患者在术后3个月时的GOS评分、ADL评分平均秩次均高于开颅组,差异有统计学意义（P<0.05）。结论 对基底节脑出血的手术治疗,内镜下血肿清除术优于传统血肿清除术。     

通过运动诱发电位比较微创穿刺术与小骨窗开颅术治疗高血压性脑出血的疗效

目的比较微创穿刺血肿粉碎清除术和小骨窗开颅血肿清除术治疗高血压脑出血运动诱发电位的影响。方法将60例患者分为微创穿刺血肿粉碎清除术36例和小骨窗开颅手术24例,治疗后第1、2周行运动诱发电位（MEP）检测并进行比较。结果治疗后1周,微创组患者中有29例可引出MEP波形,小骨窗组只有9例可引出肯定波形;治疗后2周,微创组全部病例均能引出MEP波形,小骨窗组有24例患者能引出MEP波形,但潜伏期明显长于微创组。结论微创穿刺引流不但可清除血肿．而且对脑组织损伤小,较小骨窗开颅血肿清除术有利于神经功能的恢复。     

急性颅脑损伤后进展性出血性损伤危险因素分析

目的探讨急性颅脑损伤后发生进展性出血性损伤危险因素。方法分析274例你和性颅脑外伤患者临床资料,分为进展组86例和非进展组188例,对照分析两组相关因素。结果两组除首次头颅CT时间外,年龄、性别、GCS评分、瞳孔扩大、平均动脉压、合并颅骨折、合并硬膜外血肿、合并脑挫伤、合并蛛网膜下腔出血、双侧伤、首次CT血肿量、两次CT血肿量差之间差异,均有统计学意义(P均<0.05)。GCS<12分、瞳孔扩大、合并脑挫伤、合并蛛网膜下腔出血及首次CT血肿量>10ml为发生进展性出血性损伤的独立危险因素(P均<0.05)。结论急性颅脑损伤患者及时进行头颅CT检查,对血肿量>10ml,GCS评分1<12分、瞳孔扩大及合并脑挫伤和蛛网膜下腔出血患者,应密切观察病情进展,尽早复查头颅CT以及时发现进展性出血性损伤。     

特重型颅脑损伤术中急性脑膨出的救治体会

目的探讨特重型颅脑损伤患者术中急性脑膨出的原因及防治方法。方法回顾性分析2l例特雨型颅脑损伤标准外伤大骨瓣开颅术中急性脑膨出患者的临床资料,18例患者术后寸即复查头部CT,发现迟发性颅内血肿7例,远隔部位原有血肿扩大4例,弥漫性脑肿胀6例,人而积脑梗塞1例。单侧开颅7例,双侧开颅14例;其中6例行内减压术。结果疗效评定采用GOS评分：4分（中度病残）4例,3分（重度病残）5例,2分（植物生存）3例,1分（死亡）9例。结论术中急性脑膨出的主要原因是对侧迟发性颅内血肿和弥漫性脑肿胀,积极寻找脑膨出的原因并及时止确的处理直接关系到患者的预后。     

早期微创穿刺与小骨窗开颅血肿清除术治疗高血压脑出血的疗效分析

【摘要】〓目的〓比较早期微创穿刺引流术与小骨窗血肿清除术治疗基底节区高血压脑出血的临床疗效。方法〓回顾性分析98例高血压性基底节区脑出血患者临床资料,根据资料,按不同的手术方法分为微创穿刺引流术(微创组,n=63例)和小骨窗开颅血肿清除术(小骨窗组,n=35例),评价两组患者手术和住院时间、意识障碍恢复时间、治疗1个月时神经功能缺损程度(NID)和3个月时日常生活活动能力(ADL)。结果〓微创组手术时间和住院天数显著短于小骨窗组,意识恢复时间无显著性差异;而1个月后微创组患者的NID明显低于小骨窗组(P<0.05);治疗3个月后随访,患者ADL达自理水平的较好状态者(Barthel指数≥80),两组有显著性差异(P<0.05),微创组优于小骨窗组。结论〓与小骨窗组相比,微创穿刺术可明显缩短高血压基底节区脑出血患者的手术时间和住院时间,,改善神经功能缺失程度。     

Cerebral and subdural abscess with spatio-temporal multiplicity 12 years after initial craniotomy for acute subdural hematoma. Case report

A 34-year-old man presented with a case of subdural empyema and cerebral abscess that developed 12 years after initial neurosurgical intervention for a traffic accident in 1998. Under a diagnosis of acute subdural hematoma and cerebral contusion, several neurosurgical procedures were performed at another hospital, including hematoma removal by craniotomy, external decompression, duraplasty, and cranioplasty. The patient experienced an epileptic seizure, and was referred to our hospital in March 2010. Magnetic resonance imaging revealed a cerebral abscess extending to the subdural space just under the previous surgical field. Surgical intervention was refused and antimicrobial treatment was initiated, but proved ineffective. Surgical removal of artificial dura and cranium with subdural empyema, and resection of a cerebral abscess were performed on May 12, 2010. No organism was recovered from the surgical samples. Meropenem and vancomycin were selected as perioperative antimicrobial agents. No recurrence of infection has been observed. Postneurosurgical subdural empyema and cerebral abscess are recently emerging problems. Infections of neurosurgical sites containing implanted materials occur in 6% of cases, usually within several months of the surgery. Subdural empyema and cerebral abscess developing 12 years after neurosurgical interventions are extremely rare. The long-term clinical course suggests less pathogenic organisms as a cause of infection, and further investigations to develop appropriate antimicrobial selection and adequate duration of antimicrobial administration for these cases are needed.