颅脑术后持续腰大池引流致脑疝的临床分析

Clinical analysis of cerebral hernia induced by continuous lumbar cistern drainage after craniotomy

目的探讨持续腰大池引流后脑疝形成的原因及治疗和预防措施。方法回顾性分析10例颅脑手术后持续腰大池引流致脑疝患者的临床资料。所有患者引流前均行头颅CT评估,发生脑疝后复查CT。结果 10例患者引流后均出现不同程度的脑疝表现并经CT复查证实,引流至发现脑疝的时间为0~12 d,平均3.6 d。8例患者关闭引流后脑疝缓解,2例患者脑疝症状重,死亡。结论持续腰大池过度引流可导致脑疝,及早发现脑疝的早期表现,并及时关闭引流可有效缓解脑疝。引流前进行CT评估,严格控制引流量及速度可减少其发生。

Objective To explore the causes,treatment and preventive measures of cerebral hernia induced by continuous lumbar cistern drainage after craniotomy. Methods We analyzed the clinical data of 10 patients of cerebral hernia because of the continuous lumbar cistern drainage after craniotomy retrospectively. All patients were evaluated by CT before drainage,and repeated CT scan after cerebral hernia. Results All of the patients underwent continuous lumbar cistern drainage after craniotomy appeared cerebral hernia with clinical manifestations of different degrees,which were also confirmed by CT scan. The time for the occurrence of brain herniation from the beginning of the drainage was 0 ~ 12 days,with an average of 3. 6 days. 8 of the 10 patients with symptoms of cerebral hernia were alleviated when we closed the drainage,but unfortunately 2 cases died of severe cerebral hernia. Conclusion Continuous excessive lumbar cistern drainage can induce the occurrence of cerebral hernia. Through the detection of early signs of cerebral hernia and timely closure of the drainage,we can effectively reduce the occurrence of cerebral hernia. The incidence of cerebral hernia after continuous lumbar cistern drainage can be reduced by our careful CT evaluation before the drainage,and strict control of the volume and speed appears equally important after the drainage.