小脑幕切开术在重型颅脑损伤脑疝复位中的临床研究

Clinical Study of Tentorium Cerebelli Incision Reducing Severe Brain Injury Complicated from Tentorial Herniation

目的:探索小脑幕切开术在救治重型颅脑损伤合并颞叶钩回疝复位中的作用。方法:回顾性分析1998年3月～2002年11月间救治48例重型颅脑损伤合并颞叶钩回疝患者在清除颅内血肿中骨瓣减压的基础上行小脑幕切开术的临床资料。结果:术前CT显示48例患者均有不同程度中线移位,脚间池消失17例,环池消失或受压46例,四叠体池消失12例,术后48h后行CT观察中线基本回复正常44例(91.7%),脚间池出现14例(82.3%),环池恢复42例(91.3%),四叠体池出现10例(83.3%)。结论:应用小脑幕切开术可以快速使颞叶钩回疝复位,缓解脑疝引起的继发性脑干损伤。

Objective:To explore the effect on reduction of severe brain injury complicated from tentorial hemiation by using tentorium cerebelli hiatus incision. Methods:Tentorium cerebelli hiatus incisions were made on the base of intracranial hematoma evacuation and bone flap craniotectomy on 48 patients with severe brain injury complicated from tentorial hemiation from March 1998 to Nov 2002. Results:Before operation CT show that all the patients plane in middle of the brain removes in different degree, interpeduncular cistern disappears(17 cases), ambient cistern disappears or is pressed(46 cases), superior cistern disappears(12 cases), 48 hours after operation CT show that the plane in middle of the brain reduces(44 cases,91.7%),interpeduncular cistern reduces(14 cases,82.3%), ambient cistern reduces (42 cases, 91.3%), superior cistern reduces(10 cases,83.3%). Conclusion:Tentorium cerebelli hiatus incision could reduce tentorial hemiation quickly and take effect on reducing secondary brain stem injury resulted form tentorial hemiation.