外伤性脑疝的显微手术治疗

Microsurgical treatment for tentorial herniation caused by head trauma

目的探讨显微手术天幕缘切开在重型颅脑损伤并颞叶钩回疝形成病人中的应用。方法对82例重型颅脑损伤合并颞叶钩回疝继发脑干损伤患者在开颅清除血肿的基础上加行显微镜下天幕缘切开、环池罂粟碱冲洗。结果恢复良好42例(51.0%),中残16例(19.6%),重残6例(8.2%),植物生存7例(8.7%),死亡11例(13.4%)。结论显微手术天幕缘切开、罂粟碱冲洗能够彻底解除脑干受压、防治血管痉挛进而减轻由此引发的脑干继发性损伤,降低病残率和死亡率。

Objective To explore the effect of microsurgery incision of tentorium cerebelli in the treatment of severe brain injury complicated by tentorial herniation. Methods Microsurgery incision of tentorium cerebelli and local application of papaverine were performed on the basis of intracranial hematoma evacuation on 82 patients of severe brain injury with secondary brain stem injury resulted from tentorial herniation from January 1999 to January 2004. Results 25 cases had GCS score 3-5 and 57 cases GCS 6-8. 42 cases (51.0%) survived well, 16 cases (19.6%) suffered from moderate disability, 6 cases (8.2%) severe deficit, 7 cases (8.7%) vegetative state and 11 cases (13.4%) death. Conclusion Microsurgery incision of tentorium cerebelli and local application of papaverine can take effect on reducing brain stem injury resulted from tentorial herniation and can bring down the disability and mortality of these patients.