脑室型颅内压监测在小脑大面积梗死中的临床应用

Clinical application of ventricular intracranial pressure monitoring in large area cerebellar infarction

目的 探讨脑室型颅内压监测在大面积小脑梗死临床应用中的疗效。方法 回顾性纳入2012年6月至2022年6月期间,金华市人民医院收治26例应用脑室型颅内压监测大面积小脑梗死患者26例。小脑梗死灶最大直径3~4 cm者,均先行脑室外引流术+脑室型颅内压探头置入术;小脑梗死灶最大直径>4 cm者,均行脑室外引流术+脑室型颅内压探头置入术+双侧枕下去骨瓣减压术+硬膜扩大成型术。术中如小脑膨出高于骨窗1~2 cm,即行梗死小脑组织切除的内减压术。分析脑室型颅内压监测疗效和并发症。结果 小脑梗死灶最大直径3~4 cm者7例中仅有1例因病情进展,进一步行双侧枕下去骨瓣减压、硬膜扩大成型术。小脑大面积脑梗死行脑室型颅内压监测探头植入术,以15 mmHg为颅内压增高干预界值、引流管最高点高于侧脑室平面20 cm引流条件下,未增加脑疝发生,且未增加感染率。随访3个月后GOS评分:5分13例;4分6例;3分2例;2分2例;1分3例。结论 小脑大面积梗死患者行脑室型颅内压监测,相较于单纯的脑室外引流术无附加损伤,同时结合神经系统体征和影像学变化,可更及时进行枕下后颅窝减压术,为避免不必要的手术损伤提供可能。

Objective To explore the clinical effect of ventricular intracranial pressure monitoring in treatment of the large area cerebellar infarction.Methods A retrospective analysis was conducted on 26 cases of large area cerebellar infarction undergone ventricular intracranial pressure monitoring from June 2012 to June 2022.The patients with a maximum diameter of 3-4 cm cerebellar infarction,were underwent external ventricular drainage and ventricular intracranial pressure probe implantation.For cerebellar infarction with the maximum diameter>4 cm,patients were underwent external ventricular drainage,ventricular intracranial pressure probe implantation,bilateral suboccipital decompression and expanded meningoplasty.If the cerebellum was 1-2 cm higher than the bone window during the operation,the internal decompression of the infarcted cerebellar tissue resection was performed.Outcome of patients undergone ventricular intracranial pressure monitoring was observed.Results In 7 cases with cerebellar infarction with a maximum diameter of 3-4 cm,only 1 case underwent bilateral suboccipital decompression and expanded meningoplasty due to disease progression.3 patients underwent internal decompression surgery.There was no increase in herniation or intracranial infection.After 3 months of follow-up,the GOS score was 5 in 13 cases,4 in 6 cases,3 in 2 cases,2 in 2 cases,1 in 3 cases.Conclusion Ventricular intracranial pressure monitoring in patients with large cerebellar infarction has no additional damage compared with external ventricular drainage alone,and combined with neurological signs and imaging changes,it can be used for more timely decompression of the posterior fossa under the occipital,which provides the possibility to avoid unnecessary surgical injury.