硬脑膜扩大成形术在神经外科手术中的应用

ENDOCRANIUM ENLARGED-DURAPLASTY IN NEUROSURGICAL OPERATION

目的探讨硬脑膜扩大成形术在神经外科手术中的应用价值。方法1995年10月—2004年5月,在神经外科手术中对术中需进行去骨瓣减压或有硬脑膜缺损者分别采用自体筋膜、骨膜或人工硬脑膜进行硬脑膜扩大修补(硬脑膜扩大成形术),代替以往硬脑膜敞开减压的方法,共行197例。结果术后发生脑脊液漏(包括拔管后引流管出口处脑脊液漏)12例,颅内感染4例,硬膜外血肿1例,骨窗疝2例,无骨窗疝以及疝出脑组织坏死或部分坏死发生。结论硬脑膜扩大成形术能够发挥有效的减压作用,恢复原有解剖层次,显著降低与硬脑膜缺损或减压窗有关的各种并发症的发生率。

Objective To explore the value of endocranium enlarged- duraplasty in neurosurgical operations. Methods From October 1995 to May 2004, 197 patients who would undergo craniotomy and remove the bone flaps for brain decompression received “endocranium enlarged-duraplasty” in their operations. The traditional method of “leaving dural open wide” was on the whole no longer used. Results CSF Leaks from incisions occurred in 12 cases （including CSF Leaks from drainage- tube incisions after drainage- tubes were removed ）, CNS infection occurred in 4 cases, Epidural hematomas in 1 cases, Brain herniation within the defected bone windows occurred in only 2 cases. However,in all patients,no cerebral tissue necrosis occurred within the skull- defected and dura - plastied area. Conclusion The method of endocranium enlarged- duraplasty is an effective way in regaining the original anatomical structures, producing remarkable effects in brain decompression and reducing complications related to dural and skull defects after decompression.