小儿外伤性硬脑膜下积液的手术治疗

目的：探讨小儿外伤性硬膜脑下积液的外科治疗，同时介绍一种蛛网膜造瘘和颞肌堵塞的手术治疗方法。方法：12例外伤性硬膜脑下积液患儿中3例给予单纯钻孔引流术，3例在接受多次单孔引流术后因复发而接受蛛网膜造瘘颞骨堵塞手术，另6例患儿直接给予蛛网膜造瘘及颞肌堵塞手术治疗；蛛网膜造瘘及颞肌堵塞治疗的方法为：在基础及局麻下，于患侧颞部做4cm长深达骨膜的皮肤直切口牵开，颅骨钻孔一枚后扩大成直径为3cm的骨窗，电烙切开骨下的硬脑膜，缓慢放出硬脑下积液；在蛛网膜上做一小的撕裂口；制取术野2cm宽的带蒂颞肌瓣，做适当的剪裁延长并严密止血后，将其游离段经骨孔置入硬脑膜下腔并在骨窗处适当固定。结果：3例患儿在单纯钻孔引流术后一次治愈；3例经多次钻孔引流失败者及另6例患儿均在一次性蛛网膜造瘘及颞肌堵塞手术后治愈。结论：蛛网膜造瘘及颞肌堵塞术是一种治疗外伤性硬膜脑下积液的实用方法，其操作简单，并发症少，效果理想。

Surgical treatment for traumatic subdural effusion in children

Objective To evaluate the effectiveness of arachnoid fistulation as a treatment for traumatic subdural effusion in children.Methods Of l2 children with traumatic subdural effusion,3 had trepanation and drainage, another 3 failed to repeated trepanation and drainage,and underwent arachnoid fistulation and temporal muscle grafts. The remaining 6 patients underwent local arachnoid fistulation and temporal muscle graft without drainage. Details of the surgery were as follows:under general and local anesthesia,temporal scalp was incised and a bone window of 3?cm in diameter was made. Dura mater was incised radially and the effusion was drained slowly. Arachnoid was then incised, creating a communication between subdural cavity and subarachnoid space. A 2?cm wide pedicle temporal muscle was positioned into subdural space. The scalp incision was then sutured. Results All 12 children with traumatic subdural effusion recovered uneventfully.Conclusion Arachnoid fistulation with temporal muscle graft is a safe and valuable treatment for traumatic subdural effusion in children.