重度颅脑损伤患者术中急性脑膨出

目的 探讨重度颅脑损伤患者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28例重度颅脑损伤患者,术中均采取顺序硬脑膜切开法分次切开硬脑膜.对28例病例临床资料进行回顾性分析.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19例,血肿仍大片存在4例,其他部位继发血肿5例;环池、基底池、第三脑室复现12例.出院时行COS预后评定:良好9例,中残5例,重残4例,植物生存2例,死亡8例.结论 重度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.

Acute encephalocele during surgery in patients with severe brain injury

Objective To explore the measures to prevent acute encephalocele during the decompressive craniotomy in the patients with severe brain injury.Methods The clinical data of 28 patients with severe brain injury,who were treated by extended fronto-temporo-prietal craniotomy were analyzed retrospectively.The sequential dural ineision(SDI)was performed during the operation in all the patients.Results The catastrophic encephalocele did not occur in all the cases even if very hish intracranial pressure wag caused by fulminant brain swelling in some cases.The total removal of hematomas was achieved in 19 cases,but there still was extensive hemorrhage in the operative fieId in 4 eases and secondary intracranial hematomas in the other regions in 5 cases observed on postoperative CT scan.The disappeared basal cistern and the third ventricle could be observed again in 12 eases.According to GOS,9 patienm obrained good recovery,5 was moderately disabled,4 were severely disabled,2 vegetatively survived,and 8 died.Condusion The encephalocele,which is easily produced by rapid decompression,is prevented by eontrollable decompression as early as possible and SDI in the patients with especially severe brain injury.