去骨瓣减压术后脑积水性脑膨出的临床治疗分析

Analysis of clinical treatment of posttraumatic hydrocephalus with encephalocele after decompressive craniectomy

目的探讨重度脑损伤去骨瓣减压术后脑积水性脑膨出的临床治疗方法及疗效。方法顾性分析航空总医院脑脊液病神经外科2012年01月至2014年01月之间收治的49例重度脑损伤去骨瓣减压术后脑积水性脑膨出患者的临床及影像学资料,均行脑室腹腔分流术和(或)颅骨修补术,并运用格拉斯哥预后评分(GOS评分)方法进行预后评估。结果脑室腹腔分流术后患者意识及神经功能障碍均有不同程度好转者39例(79.6%),无明显变化甚至恶化死亡者共10例(20.4%)。其中恢复良好者10例(20.4%),中度残疾者8例(16.3%)、重度残疾者5例(10.2%)、植物生存者23例(47.0%)、死亡者3例(6.1%)。结论创伤后脑积水诊断延误或治疗方法不当易造成脑膨出,导致缺血缺氧性脑软化、脑萎缩,影响患者预后。脑室腹腔分流术是治疗创伤后脑积水合并脑膨出患者的有效方法,有助于改善患者意识及神经功能。

Objective To investigate the clinical treatment of posttraumatic hydrocephalus with encephalocele after decompressive craniectomy in patients with severe traumatic brain injury. Methods The clinical and imaging data of posttraumatic hydrocephalus with encephalocele after decompressive craniectomy in 49 patients with severe traumatic brain injury in Aviation General Hospital of China Medical University from Jan. 2012 to Jan. 2014 were analyzed retrospectively. All patients were performed ventriculoperitoneal shunt and （or） cranioplasty, and using the Glasgow Outcome Scale （GOS） method to evaluate the prognosis. Results After ventriculoperitoneal shunting, the consciousness and neurological function impairment were improved in 39 cases （79.6%）, no improvement or death in 10 cases （20.4%）. The well recovered in 10 cases （20.4%）, moderate disability occurred in 8 cases （16.3%）, severe disability occurred in 5 cases （10.2%）, survived in vegetative state in 23 cases （47.0%） and death occurred in 3 cases （6.1%）. Conclusion The delayed diagnosis or improper treatment of Post-traumatic hydrocephalus could easily lead to encephalocele and encephalodialysis and brain atrophy, Which will affects the prognosis of the patients. Ventriculoperitoneal shunt is an effective method for treatment of post-traumatic hydrocephalus combined with encephalocele, and the result will help to improve patients consciousness and neurological function.