“S”形切口+跨窦骨瓣开颅术治疗跨上矢状窦硬膜外血肿的疗效

目的 探讨“S”形切口+跨窦骨瓣开颅术治疗跨上矢状窦硬膜外血肿的疗效。方法 回顾性分析2017年12月至 2019年12月收治的19例跨上矢状窦硬膜外血肿的临床资料。术前行颅脑冠状位、矢状位CT及颅骨三维重建，根据影像学所示行“S”形皮瓣+跨窦骨瓣开颅术。结果 术中见顶骨凹陷性骨折7例，颞顶骨骨折15例，其中骨折线跨上矢状窦12例；上矢状窦出血12例，骨折板障出血3，导静脉及硬膜血管出血4例；术后24~72 h多次复查头部CT，显示硬膜外血肿完全清除，无再出血。出院时按GOS评分评估预后:恢复良好14例，中残3例，重残1例，植物生存1例。术后随访3~24个月无血肿复发。结论 采用“S”形切口+跨窦骨瓣开颅术治疗跨上矢状窦硬膜外血肿，能有效地止血并处理上矢状窦损伤，同时避免上矢状窦受压，术后再出血风险低，并发症少，疗效好。

Efficacy of transsinus craniotomy using S-shaped incision for epidural hematoma lying over the superior sagittal sinus

Objective To explore the clinical efficacy of transsinus craniotomy using S-shaped incision for the epidural hematomas lying over the superior sagittal sinus. Methods A retrospective analysis was performed on the clinical data of 19 patients with epidural hematoma lying over the superior sagittal sinus who underwent transsinus craniotomy using S-shaped incision from December 2017 to December 2019. Preoperative coronal and sagittal CT and three-dimensional reconstruction of skull were performed on the all the patients and the transsinusal craniotomy using S-shaped incision was performed according to the imaging findings. Results During the operation, depressed parietal bone fracture was found in 7 patients, temporo-parietal bone fracture in 15, fracture line crossing the superior sagittal sinus in 2, superior sagittal sinus hemorrhage in 12, hemorrhage due to diploe injury in 3, and hemorrhage due to injury of emissary veins and dural vessels in 4. Reexamination of head CT scans 24~72 hours after the operation showed that the epidural hematoma was completely removed and there was no rebleeding. According to GOS score on discharge, 14 patients were recovered well, 3 were moderately disabled, 1 was severely disabled, and 1 was vegetatively survived. The follow-up (range, 3~24 months) showed no recurrence of hematoma in all the patients. Conclusions For the patients with epidural hematoma lying over the superior sagittal sinus, transsinus craniotomy using S-shaped incision can effectively stop bleeding and cure the superior sagittal sinus injury which can avoid compression of the superior sagittal sinus. The risk of rebleeding is low, the complications are light, and the curative effect is good.