额叶脑挫裂伤伴额眶前颅底骨折的显微手术治疗

Microsurgical treatment of frontal lobe brain contusion complicated with anterior cranial base and cranio-orbital traumatic fractures

目的探讨额叶脑挫裂伤伴额眶前颅底骨折的显微手术治疗方法及效果。方法回顾性分析18例额叶脑挫裂伤伴额眶前颅底骨折的临床表现与手术治疗效果。其中男性16例,女性2例;年龄35~68岁,平均41.5岁。致伤原因:道路交通伤9例,异物撞击伤7例,坠落伤1例,击打伤1例。入院时GCS评分13~15分3例,9~12分7例,5~8分8例。18例患者均行开颅显微镜下挫裂伤组织及血肿清除术,一期前颅底重建修补术,其中3例行一期视神经管减压术。结果随访6个月~2年,GOS评分5分11例,4分5例,3分1例;死亡1例。术后早期脑脊液漏2例,经非手术治疗均在2周内脑脊液漏消失。3例视力障碍患者有1例术后视力改善。结论早期彻底清创,显微镜下彻底清除额叶失活挫裂伤组织及血肿,严密缝合硬脑膜,尽量恢复额眶前颅底骨质完整,视神经损伤患者一期视神经管减压,术后综合治疗,可减少神经功能障碍,改善患者预后。

Objective To explore the microsurgery treatment methods and effects for the frontal lobe brain contusion complicated with anterior cranial base and cranio-orbital traumatic fractures. Methods The clinical manifestations and surgical treatment of 18 patients with frontal lobe brain contusion complicated with anterior cranial base and cranio-orbital traumatic fractures were analyzed retrospectively. There were 16 males and 2 females,aged of35-68（ average 41. 5） years. Cause of injury included 9 cases of traffic accident,7 cases of foreign body impact injury,1 case of falling injury,and 1 case of strikes injury. At the time of admission,GCS score was 13-15 points in 3 cases,9-12 points in 7 cases and 5-8 points in 8 cases. All 18 patients underwent microscopically contusion and hematoma removal,and the one stage of skull base reconstruction and repair was performed. Three patients accepted the one stage cranio-orbital decompressive operation. Results All patients were followed up for 6 months to 2 years,and GOS scored 5 points in 11 cases,4 points in 5 cases,3 points in 1 case,and 1 case was dead. Two cases of cerebrospinal fluid leakage were observed in the early postoperative period,and the cerebrospinal fluid leakage disappeared in 2 weeks after conservative treatment. One of the three patients with visual impairment had improved vision after surgery. Conclusion Early thorough debridement,thorough removal of frontal lobe contusion and hematoma under a microscope,carefully sutured dura mater,one stage repair for the anterior cranial base and cranio-orbital traumatic fractures,early optic canal decompression for optic nerve injury patients and postoperative comprehensive treatment can reduce nerve dysfunction and improve the prognosis of patients.