中央型脑疝的临床表现及术式探讨

Clinical Presentation and Surgery of Central-brain Herniation

目的:探讨额颞叶脑挫裂伤/迟发脑内血肿引起脑疝的特点,提高手术救治水平。方法:采用保留额部骨瓣的额颞顶部开颅颞肌下减压术,在脑疝代偿期进行手术治疗。结果:额颞叶脑挫裂伤/迟发脑内血肿并脑疝患者手术治疗37例,运用GOS判断预后,代偿期手术34例Ⅴ级,失代偿期手术3例Ⅳ(情感、精神活动障碍)。结论:额颞顶部开颅利于脑挫裂伤灶彻底清创、保护有活力的额叶脑组织。颞肌下减压比额部骨瓣减压能更好的缓解颅内深部压力;保留额部骨瓣,更好的保护了额叶脑组织及其功能,防止术后严重并发征及容貌丑形。

Objective：To investigate the characteristic of cerebral herniation caused by fronto-temporal brain contusion and delayed intracerebral hematoma and improve surgical treatment level.Methods：Fronto-temporo-parietal craniotomy reserving forehead bone flap and sub-emporalis-decompression was employed before the brain herniation was decompensated.Results：37 patiants suffered fronto-temporal brain contusion and delayed intracerebral hematoma were operated.The prognosis was favorable in 34 patiants with GOS score of 5 and 3 patiants with GOS score of 3（with emotional and mental disorder）.Conclusion：Fronto-temporo-parietal craniotomy is conductive to completely debride the necrotic brain and protect the viable brain of frontal lobe.Pressure of deep region was more relieved in sub-emporalis-decompression compared with frontal bone flap decompression.Reserving forehead flap is better to protect the frontal lobe brain and their functions,prevent severe postoperative complications and to avoid ugly appearance.