骨瓣开颅术治疗骑跨横窦的硬膜外血肿24例

Bone flap craniotomy in the treatment of epidural hematoma straddling transverse sinus in 24 cases

目的探讨骨瓣开颅术治疗骑跨横窦硬膜外血肿的手术指征、方法及疗效。方法回顾性分析2003年7月~2011年3月我院神经外科骨瓣开颅术治疗24例骑跨横窦硬膜外血肿患者的临床资料。结果本组24例患者术后3 d复查头部CT示血肿基本清除干净,术区无继发性出血,骨瓣均解剖复位;术后3月进行GOS评分,其中,5分18例,4分4例,3分2例,无死亡及植物生存病例。结论对血肿总量〉30 mL、幕下血肿〉10 mL或血肿量不大但有脑积水、环池受压及四脑室消失的患者应采取积极的手术治疗,应用跨过横窦的骨瓣开颅术方法安全可靠,疗效好。

Objective To investigate the operation indications,methods and curative effect of bone flap craniotomy in the treatment of epidural hematoma straddling transverse sinus.Methods The clinical data of 24 cases of patients with epidural hematoma straddling transverse sinus,who were treated with bone flap craniotomy in neurosurgery department of our hospital from July 2003 to March 2011 were analyzed retrospectively.Results 3 days after operation,the CT scan showed that all the hematomas were mainly cleaned and there was no secondary hemorrhage happened,the bone flaps were anatomic reattached.The curative effect was evaluated by GOS score three months after operation,there were 18 cases scored 5 points,4 cases scored 4 points and 2 cases scored 2 points,no vegetative patient and no patient was dead.Conclusion Timely surgical interventions should be performed in patients with the total straddling hematoma volume more than 30 mL or infratentorial hematoma volume more than 10 mL or the hematoma is not large enough but complicated with hydrocephalus or annular pool compressed or the forth ventricle disappeared.The bone flap craniotomy which pass the transverse sinus is safe and effective in the treatment of these cases.