颅盖部巨大骨纤维异常增殖症合并大面积脑梗死去骨瓣减压术1例并文献复习

Emergency surgical decompression for an acute large hemispheric infarction patient with massive fibrous dysplasia of the supratentorial calvaria(report of 1 case and review of literature)

目的探讨颅盖部巨大骨纤维异常增殖症合并大面积脑梗死开颅去骨瓣减压术的方式。方法回顾性分析1例颅盖部巨大骨纤维异常增殖症合并左侧额颞顶叶急性大面积脑梗死,行开颅去骨瓣减压术患者的临床资料;并对相关文献进行复习。结果患者表现意识障碍(昏睡状态)、右侧偏瘫,病情进行性加重;头颅CT示左侧额颞顶叶大面积脑梗死,局部颅骨增厚、骨质密度异常。即行开颅去骨瓣减压术,术中先采用电钻和手摇钻减低骨窗边缘异常增厚的颅骨厚度,再在个别部位将颅骨钻透并用椎板咬骨钳暴露出部分硬脑膜,最后用铣刀沿钻薄的颅骨完整铣除骨瓣。患者术后意识逐渐恢复正常。结论本例患者的手术方法对颅盖部巨大骨纤维异常增殖症合并其他脑部疾病需行开颅手术的患者也是可行的。先沿其边缘减低异常颅骨的厚度再铣除骨瓣是相对快捷和安全的开颅手术方法。

Objective To investigate the methods of decompressive craniectomy for giant fibrous dysplasia of cranium combined with massive cerebral infarction.Methods The clinical data of a patient with giant fibrous dysplasia of cranium combined with acute massive cerebral infarction in left frontal,temporal and parietal lobe was analyzed retrospectively and the relevant literature were reviewed.Results The patient showed disturbance of consciousness(drowsiness),right hemiplegia,progressive aggravation of the disease.The cranial CT showed a large area of cerebral infarction in the left frontotemporal lobe,local skull thickening and abnormal bone density.Then,the skull was drilled through some parts of the skull and exposed part of the dura mater with lamina biting forceps.Finally,the bone flap was completely milled along the thin skull with a milling cutter.The consciousness of the patients gradually returned to normal.Conclusion The operation of this patient is also feasible for patients with giant fibrous dysplasia of cranial cap complicated with other brain diseases and requiring craniotomy.It is a relatively fast and safe method to reduce the thickness of abnormal skull along its edge and then milling the bone flap.