外伤横窦骑跨性硬膜外血肿的临床诊断与治疗

Clinical Diagnosis and Treatment of Traumatic Transverse Sinus Epidural Hematoma

目的探讨横窦骑跨性硬膜外血肿的临床特征、早期诊断、手术方式及疗效。方法回顾性分析18例横窦骑跨性硬膜外血肿的临床资料、手术方式及疗效。单侧血肿<20ml者采用旁正中切口,单侧血肿≥20ml者采用枕后马蹄形切口或枕下倒钩形切口,双侧血肿采用正中切口。结果恢复良好15例,中、重度致残各1例,植物生存1例,死亡0例。结论由于缺乏典型的临床特征,早期诊断依赖头颅CT扫描及严密的病情观察,骨瓣成形术清除横窦骑跨性硬膜外血肿安全且能更好地避免横窦受压,效果良好。

Objective To study the clinical symptoms, early diagnosis and surgical treatment of transverse sinus epidural hematoma（TSEH）. Methods The clinical data,diagnosis, surgical method and its curative effect of 18 cases with TSEH were analyzed retrospectively. The paramedian incision was adapted to unilateral hematoma smaller than 20 ml, post-occipital hook incision or suboccipital reverse hook incision to unilateral hematoma larger than 20 ml, and median incision to bilateral hematoma. Results Good recovery in 15 cases,moderately and severe disability each in 1 cases, vegetative state in 1 case. Conclusions Due to lack of typical clinical symptoms, the early diagnosis relies on CT scan and close observation. The cranioplasty surgery can clear TSEH and keep effectively transverse sinus from being pressurized.