Nathoo N, Boodhoo H, Nadvi S S, Naidoo S R, Gouws E
Department of Neurosurgery, Wentworth Hospital, School of Clinical Sciences, University of Natal, Durban, South Africa.
Neurosurgery. 2000 Nov;47(5):1117-22; discussion 1123. doi: 10.1097/00006123-200011000-00018.
Transcranial stab injuries remain a frequent cause of emergent neurosurgical admissions to neurosurgical units in South Africa. Brainstem stabs are an uncommon, yet often fatal, form of brain injury.
A retrospective audit of 597 patients with transcranial stab injuries admitted to our unit over a 12-year period (January 1987 to December 1998) identified 17 patients (2.85%) with brainstem stab injuries. The computed tomographic scans of all patients were analyzed, and a detailed autopsy examination of the skull and its contents was performed in all patients who died. Stepwise linear regression analysis was used to formulate a predictive model of outcome for the entire series of 597 patients.
The majority of the patients were males (16 patients), and the study group had a mean age of 28.65 +/- 9.59 years and a mean Glasgow Coma Scale score of 8.59 +/- 2.76. Knives (82%) were the most common instruments of penetration. Cerebral angiography identified 3 patients with vascular abnormalities, and autopsy revealed an additional 4 patients with vascular injury. Emergency ventriculostomy was performed in 10 patients for obstructive hydrocephalus. Four of the 17 patients survived (76.5% mortality). Factors significantly predictive of outcome in patients with transcranial stab injuries were the Glasgow Coma Scale score (F = 43.7), the occurrence of intraventricular hemorrhage (F = 22.8), the type of associated lesion (intracranial bleed, vascular abnormality, or brain abscess) (F = 5.9), and the number of operations (F = 3.2).
The Glasgow Coma Scale score is the most significant predictor of outcome in low-velocity transcranial stab injuries. Brainstem stab injuries have a great propensity for vascular damage. Survivors are incapacitated by severe, fixed neurological deficits.
在南非，经颅刺伤仍是神经外科病房紧急收治患者的常见原因。脑干刺伤是一种罕见但往往致命的脑损伤形式。
对1987年1月至1998年12年间收治于我科的597例经颅刺伤患者进行回顾性审计，确定了17例（2.85%）脑干刺伤患者。分析了所有患者的计算机断层扫描结果，并对所有死亡患者的颅骨及其内容物进行了详细的尸检。采用逐步线性回归分析为整个597例患者系列建立了预后预测模型。
大多数患者为男性（16例），研究组的平均年龄为28.65±9.59岁，格拉斯哥昏迷量表平均评分为8.59±2.76。刀具（82%）是最常见的穿刺工具。脑血管造影发现3例血管异常患者，尸检又发现4例血管损伤患者。10例患者因梗阻性脑积水行急诊脑室造瘘术。17例患者中有4例存活（死亡率76.5%）。经颅刺伤患者预后的显著预测因素包括格拉斯哥昏迷量表评分（F = 43.7）、脑室内出血的发生（F = 22.8）、相关病变类型（颅内出血、血管异常或脑脓肿）（F = 5.9）以及手术次数（F = 3.2）。
格拉斯哥昏迷量表评分是低速经颅刺伤患者预后的最重要预测因素。脑干刺伤极易导致血管损伤。幸存者因严重的、固定的神经功能缺损而丧失能力。
