后颅窝枕下减压术治疗大面积小脑梗死的预后分析

Prognosis analysis of posterior fossa suboccipital decompression for large area cerebellar infarction

目的分析后颅窝枕下减压术治疗大面积小脑梗死的手术时机、手术方式及预后。方法回顾性分析济南军区总医院神经外科自2010年1月至2018年2月符合纳入标准的大面积小脑梗死患者的临床资料。所有患者于CT及MRI检查确诊后24 h内行后颅窝枕下减压术,如有急性脑积水发生,先行脑室外引流术,再进行后颅窝枕下减压术。结果本组患者12例,术前CT显示出现脑积水者4例,先行脑室穿刺外引流术,后行颅窝减压术。根据GOS评分评价患者外科治疗效果:良好7例,中残2例,重残1例,植物生存1例,死亡1例。结论后颅窝减压术能避免大面积小脑梗死临床症状恶化进行性发展,改善预后。

Objective To investigate the timing, mode and prognosis of posterior fossa suboccipital decompression for massive cerebral infarction. Methods The clinical data of patients with large area cerebellar infarction who met the inclusion criteria from January 2010 to February 2018 in Department of Neurosurgery, General Hospital of Ji＇nan Military Area were retrospectively analyzed. All patients underwent posterior fossa suboccipital decompression within 24 h after the diagnosis was confirmed by CT and MRI. If acute hydrocephalus occurred, ventricular drainage was performed first, and then posterior fossa suboccipital decompression was performed. Results There were 12 cases in this group. Preoperative CT showed hydrocephalus in 4 cases. Ventricular puncture and drainage were performed before cranial fossa decompression. According to GOS prognostic score, 7 cases were good, 2 cases were moderately disabled, 1 case was severely disabled, 1 case was vegetative survival and 1 case died. Conclusion Posterior cranial fossa decompression can avoid progressive deterioration of clinical symptoms and improve prognosis in large area of cerebellar infarction.