去骨瓣减压术后与颅骨缺损相关的并发症及其防治

Complications associated with skull defects after decompressive craniectomy and their

去骨瓣减压术(DC)作为抢救性手术在治疗由脑卒中、重症颅脑外伤、颅内感染、自发性蛛网膜下腔出血等疾病引起的颅内压危象中得到了广泛认可,在挽救生命的同时,各种形式的术后并发症也受到了广泛关注。并发症主要包括术后脑膨出、颅内感染、继发癫痫、硬膜下积液、交通性脑积水、反常脑疝及皮瓣下沉综合征等,其发病原因并不明确。早期行颅骨修补可以改善DC后患者神经功能症状,同时可以明显降低术后脑积水、硬膜下积液等并发症的发病率,但早期修补的时间节点尚存争议,需要更多临床研究进行明确。本文主要针对骨瓣减压术后与颅骨缺损相关的并发症类型、发病时间及防治方法作一综述,以期为临床医师提供参考和借鉴。

Decompressive craniectomy(DC)as a rescue operation has been widely recognized in the treatment of refractory intracranial hypertension caused by stroke,severe traumatic brain injury,intracranial infection,spontaneous subarachnoid hemorrhage and other diseases.While saving lives,various forms of postoperative complications have also been widely concerned.Complications mainly include postoperative encephalocele,intracranial infection,secondary epilepsy,subdural effusion,communicating hydrocephalus,abnormal brain hernia and skin flap sinking syndrome,etc.,and its pathogenesis is not clear.Early cranioplasty can improve the neurological symptoms of patients after decompression craniectomy,and significantly reduce the incidence of complications such as postoperative hydrocephalus,subdural effusion,etc.However,the timing node of early cranioplasty remains controversial,which requires more clinical studies to clarify.This article mainly summarizes the types,onset time and prevention methods of complications related to skull defect after decompressive craniectomy,in order to provide reference for clinical physicians.