彩色超声对重型颅脑损伤术中急性脑膨出的诊断及治疗价值

目的 探讨彩色超声对重型颅脑损伤术中急性脑膨出的诊断及治疗价值.方法 回顾性分析2013-12至2018-12武警北京总队医院和武警四川总队医院收治的32例重型颅脑损伤术中发生急性脑膨出患者的临床资料,术中采取超声检查的方法,诊断脑膨出的病因及进一步指导手术治疗方案.观察记录术中超声诊断脑膨出的病因类别、部位特点(包括...

Applicability of ultrasound in diagnosis and treatment intraoperative acute encephaloceles with severe craniocerebral injury

Objective To investigate the applicability of ultrasound in the diagnosis and surgical treatment of acute encephaloceles with severe craniocerebral injury. Methods The clinical data on 32 patients who had developed acute encephaloceles during surgery for severe craniocerebral injury in Beijing Municipal Corps Hospital and Sichuan Provincial Corps Hospital of Chinese People's Armed Police Force between December 2013 and December 2018 was retrospectively analyzed. Ultrasonography was used during the operations to diagnose the cause of encephaloceles and to guide the related surgeries. Furthermore, the etiological category and site characteristics (including cases) of encephaloceles diagnosed by intraoperative ultrasonography were observed, while the Glasgow Outcome Score (GOS) was recorded 6 months after surgery. Results According to the characteristics of skull fractures shown by preoperative CT in 8 cases, it was speculated that the cause of intraoperative encephaloceles might have been delayed intracranial hematoma on the contralateral side. Intraoperative ultrasonography confirmed that the contralateral skull fracture was delayed epidural hematoma and subdural hematoma. The etiology of encephaloceles was difficult to determine in other 24 cases, but could be revealed by ultrasound examination which showed 9 cases of epidural hematoma or subdural hematoma on the contralateral side of the surgery, 7 cases of intracerebral hematoma on the same side of the surgery, 2 cases of extramembranous hematoma, 2 cases of subdural hematoma and 4 cases of severe ipsilateral contusion and extensive brain swelling. Thirty-two cases had their intracranial hematoma or contused brain tissue surgically removed under ultrasound guidance, which effectively relieved the brain bulge. Six months after operations, the 32 patients were classified according to the Glasgow Outcome Score (GOS). Eight cases were classified as good recovery (25.00%), 9 cases moderate disability (28.12%), 7 cases severe disability (21.88%), 4 cases persistent vegetative state (12.50%) and 4 cases died (12.50%). Conclusions Intraoperative ultrasound can accurately diagnose the cause of acute encephaloceles during severe head injury,facilitate surgical treatment of encephaloceles, shorten the duration of surgery and raise the success rate of treatment.