外伤性脑积水的诊断与治疗

目的 探讨外伤性脑积水的临床特点及治疗方法.方法 对12例患者的影像学资料、治疗方法和结果进行回顾性分析.结果 12例均为外伤后交通性脑积水.发生时间:2周内1例,3～4周9例,5～6周2例.全部行侧脑室-腹腔分流手术(V-P),手术在首次发现脑积水后4～58 d进行,其中1例内手术9例,2周内手术2例,最长1例58 d.手术侧脑室额角置管9例,三角区置管3例,均采用中压型分流管.本组病人术后临床观察,在意识水平、精神障碍、语言功能、视力等方面均有不同程度的改善.随访6个月～4年,恢复良好7例,一般5例,无死亡病例.结论 外伤性脑积水是脑损伤急性期后继发性损害主要表现形式之一,常见于重型闭合性颅脑损伤后,可严重影响病人预后.一旦发生较明显脑积水,积极采取V-P分流术,妥善、持续控制颅高压,能促进病人恢复,明显改善患者预后.

Clinical diagnosis and treatment of traumatic hydrocrania

Objective To probe the clinical features and treatments of traumatic hydrocrania.Methods Image data,therapeutic means and outcome from 12 cases were retrospectively analyzed.Results All the 12 cases were sufferers of post-traumatic communicative hydrocrania,which occurred within the previous 2 weeks(1 case),3 to 4 weeks (9 cases) and 5 to 6 weeks(2 cases) respectively.All underwent ventriculus lateralis-peritoneal shunt(v-p) within 4 to 58 days of the occurrence,with 9 cases of tube-positioning on the operational side frontal angle and 3 cases on the trigone,medium pressure shunt applied in each case.Post-operational observation revealed that all the cases had improvement of various degrees in consciousness,mental obstacle,language ability and sight.Follow-up of(0.5) to 4 years saw 7 cases of good recovery,5 cases of general condition and no case of death. Conclusion Post-traumatic hydrocrania is one of the severe forms of secondary lesion,which often occurs after closed craniocerebral injury and influences to a great degree the sufferer's prognosis.Adoption of v-p in time and proper control of intracranial hypertension in a sustained way will stimulate recovery and improve prognosis of the patients.