标准脑外伤大骨瓣开颅术在恶化型颅高压救治中的应用

目的　恶化型颅高压是否采用大骨瓣减压仍存在争议 ,本文主要探讨标准脑外伤大骨瓣开颅术在进展性难治性颅高压救治中的作用。方法　对 10 0例进展性难治性颅内高压应用标准脑外伤大骨瓣开颅术治疗并进行回顾性分析。其中颅脑外伤 83例 ,恶化型大面积大脑梗死 15例 ,肿瘤卒中并脑疝 2例。结果　 83例脑外伤治愈 3 8例 ,轻、中残 11例 ,重残 6例 ,死亡 19例 ,病死率为 2 9% ,中、重残率为 2 6%。 15例恶化型大面积大脑梗死恢复良好 3例 ,轻、中残 6例 ,重残 4例 ,死 2例 ,病死率为 13 3 %。 2例肿瘤卒中均存活。结论　标准脑外伤大骨瓣开颅术能有效地缓解颅内高压 ,可作为恶化型颅内高压的首选术式 ,适应于外伤后急性弥漫性半球或全脑肿胀、广泛脑脑挫裂伤合并硬膜下血肿、单纯性广泛硬膜下血肿但出血来源不明者、硬膜外血肿合并晚期脑疝和恶化型大面积大脑梗死的手术治疗。对术前已有脑疝形成的病人同时行脑疝复位或小脑幕切开术能能改善病人的预后

Application of standard large trauma craniotomy in the treatment of uncontrollable intracranial hypertention

Objective Decompressive crani ot omy in the treatment of uncontrollable intracranial hypertention is not generall y accepted.The aim of our study was to assess the value of standard large trauma craniotomy in patients with uncontrollable intracranial hypertention.Me thods We reviewed 100 patients with deteriorating increased intracrania l pressure(ICP) who were treated with standard large trauma craniotomy and large decompressive craniotomy.Among 100 patients,there were 83 patients with severe brain injure,15 patients with large hemispheric infarction and 2 patients with t umor stroke.Results Of the 83 patients with brain injure,there were 38 cases(45.7%) cured well,11 cases with severe deficits,6 cases with moder ate disability,19 cases(21.7%) died after therapy.Of the 15 patients with large hemispheric infarction,there were 3 cases(20%) recoveryed,4 cases(26.7%) with se vere deficits,6 cases(40%) with mild and moderate disability,2 cases(13.3%) die d after therapy.Conclusion Standard large trauma craniotomy can effectively reduce the ICP,and it should be routinely performed when indicated uncontrollable intracranial hypertention occurs.This method can be used in postt raumatic acute diffuse(or hemisphere) swelling,extensive brain contusion and lac eration associated with subdural hematoma,extensive simple subdural hematoma wit hout unclearly defined hemorrhage source,epidural hematoma associated with brain hernia and deteriorating patients with large hemispheric infarction.The outcome will be improved by performing tentorium cerebelli hiatus in those cases compli cated with tentorial herniation.