去骨瓣减压术后硬膜下积液的治疗措施分析

目的探讨开颅去大骨瓣减压术后并发硬膜下积液的治疗方法。 方法回顾性分析双流区第一人民医院神经外科自2017年1月至2019年12月收治的20例去大骨瓣减压术后并发硬膜下积液患者的临床资料，待脑水肿高峰期渡过后给予弹力帽外固定包扎、Omaya囊置入穿刺抽吸、塑形钛网修补、高压氧治疗。观察硬膜下积液量、神经功能障碍症状、改良Rankin量表评分情况。 结果本组20例患者中，6例为双侧额颞顶硬膜下积液，2例为大脑镰旁纵裂池内积液，12例为同侧额颞顶硬膜下积液，其中2例为同侧进展型硬膜下积液，放置Omaya囊抽吸；20例患者均给予弹力帽外固定包扎，后期均予以塑形钛网修补及高压氧治疗（3个疗程，30次）。所有患者术后随访6个月，复查头颅CT未见硬膜下积液复发。 结论去骨瓣减压术后并发硬膜下积液，通过应用弹力帽外固定包扎、抽吸、早期颅骨修补、高压氧手段治疗，可取得较好的效果。

Analysis of treatment measures of subdural effusion after decompression craniectomy

ObjectiveTo explore the treatment of subdural effusion after decomperssive craniectomy. MethodsThe data of 20 cases with subdural effusion after decomperssive craniectomy in Neurosurgery Department of the First People’s Hospital of Shuangliu District from January 2017 to December 2019 were analyzed retrospectively. After the peak period of brain edema, external fixation of elastic cap, puncture and suction of Omaya capsule implantation, plastic titanium mesh repair and hyperbaric oxygen therapy were performed. The amount of subdural effusion, symptoms of neurological dysfunction, and modified Rankin scale were observed. ResultsAmong the 20 patients in this group, 6 cases had bilateral frontal temporal subdural effusion, 2 cases had effusion in the falx cerebri pool next to longitudinal crack, 12 cases had ipsilateral frontal temporal subdural effusion, of which 2 cases had ipsilateral progress subdural effusion, and Omaya capsule suction was placed; 20 patients were given elastic cap external fixation bandage, and all patients underwent plastic titanium mesh repair and hyperbaric oxygen treatment (3 courses, 30 times). All patients were followed up for 6 months after operation, and CT reexamination showed no recurrence of subdural effusion. ConclusionDecompressive craniectomy accompanied by subdural effusion, the good effect can be achieved by applying external fixation bandage of elastic cap, suction, early cranial repair and hyperbaric oxygen treatment.