颅骨修补治疗颅脑创伤术后颅骨缺损的时机与材料选择

Timing and material for cranioplasty in patients with posttraumatic skull defects

颅骨缺损是颅脑创伤患者常见的后遗症,多由去骨瓣减压术等原因导致。创伤性颅骨缺损除导致脑组织在外界压力下出现变形及移位外,对脑血流、脑部代谢及脑脊液循环均有影响,可产生对侧轴外积血或积液、脑组织灌注减低、代谢紊乱、脑电活动紊等病理改变。颅骨修补能够改善脑的血供与代谢,有助于纠正脑脊液循环。对于颅脑创伤去骨瓣减压术后导致的颅骨缺损,尽早行颅骨修补术已经成为越来越多神经外科医师的选择。因此,笔者就颅骨修补治疗颅脑创伤术后颅骨缺损的时机与材料选择作一综述,以梳理相关研究进展,为临床实践提供一定启发与借鉴。

Skull defect is commonly seen after traumatic brain injury and is often caused by decompressive craniectomy.Despite from pressure induced deformation or translocation,traumatic skull defect can also lead to multiple pathological influences to the brain,including cerebral blood flow or metabolism reduction,cerebrospinal fluid circulation disturbance,contralateral hematoma or effusion,and cerebral electrical activity changes.Cranioplasty can improve cerebral perfusion and metabolism as well as to support the rectification of cerebrospinal fluid circulation.Currently,early cranioplasty has been well accepted by neurosurgeons for the treatment of skull defect after decompressive surgery for traumatic brain injury,but the exact time point is still under debate and requires further clinical evidence.Therefore,the authors review the research progress of timing and material choices for cranioplasty of patients with skull defect after traumatic current researches,so as to provide possible inspiration for clinical practice.