创伤性大脑浅静脉损伤(附18例报道)

Traumatic superficial cerebral veins injury:report of 18 cases

目的探讨创伤性大脑浅静脉损伤机制与创伤性脑梗死的关系对预后的影响及对创伤性大脑浅静脉的有效处理措施。方法2006-06～2007-02我科收治颅脑损伤患者330例,其中18例合并有术中证实的大脑浅静脉损伤。分析本组患者的临床及影像学资料。结果伴有大脑浅静脉损伤的18例中合并颅骨骨折12例,18例均合并有急性硬膜下或脑内血肿,并发有不同程度的创伤性脑梗死。伤后6个月,18例患者中预后较佳5例,预后不佳13例。结论颅骨骨折直接损伤是导致大脑浅静脉损伤的主要原因,大脑浅静脉损伤是导致创伤性脑梗死的重要原因,合并有大脑浅静脉损伤的颅脑损伤患者预后差,死残率高。术中注意保护受损大脑浅静脉和给予受损静脉周围充分减压,以及术后防止受伤静脉栓塞和血管痉挛是提高此类患者预后的有效措施。

Objective To investigate the mechanisms of superficial cerebral veins injury and explore its relationship with traumatic cerebral infarction and the prognosis. Methods 18 patients with traumatic superficial cerebral veins injury were admitted to our hospital from June 2006 to February 2007. The clinical and radiographic data was analyzed. Results 12 cases of skull fracture and 18 cases of subdural or/and cerebral hematoma were found. All of the 18 cases had traumatic cerebral infarction. 5 patients had good outcomes, and 13 had poor outcomes. Conclusion Skull fracture is the main cause of superficial cerebral veins injury, and superficial cerebral veins injury is one of the key factors which causes traumatic cerebral infarction. Patients with superficial cerebral veins injury were subject to poor prognosis and have relatively high morbidity and mortality. Decompression and protection of the injured superficial cerebral veins during the operation and the prevention of venous embolism and angiospasm after the operation can improve the prognosis.