大骨瓣开颅加天幕切开术在创伤性脑疝手术中的应用

Application of craniotomy with large bone flap plus transtentorial hernia incision in traumatic hernia surgery

目的探讨重型颅脑损伤合并脑疝患者的有效手术方案。方法对86例重型颅脑外伤合并脑疝患者采用标准外伤大骨瓣开颅,清除病灶必要时内减压后,术中轻抬颞叶,直视下切开天幕1-2cm扩大天幕裂孔使脑疝复位。结果预后较好63例,植物生存4例,死亡19例,死亡率22.1%。结论标准外伤大骨瓣开颅加天幕切开术可以降低创伤性脑疝的病死率及致残率。

Objective To study the effective surgical methods for patients with severe craniocerebral injury complicated by cerebral hernia. Methods Standard craniotomy with large bone flap was performed for severe craniocerebral injury complicated by cerebral hernia in 86 patients followed by decompression when necessary after removal of the lesions. The temporal lobe was incised about 1-2cm to expand the transtentorial hernia for the reposition of cerebral hernia under direct vision. Results Favorable prognosis was achieved in 63 patients, with 4 patients in persistent vegetative status and 19 patients died. The mortality rate was 22.1%. Conclusion Standard craniotomy with large bone flap plus transtentorial hernia incision can decrease the mortality and disability rate of patients with traumatic cerebral hernia.