Jagannathan Jay, Okonkwo David O, Dumont Aaron S, Ahmed Hazem, Bahari Abbas, Prevedello Daniel M, Jane John A, Jane John A
Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
J Neurosurg. 2007 Apr;106(4 Suppl):268-75. doi: 10.3171/ped.2007.106.4.268.
The authors examine the indications for and outcomes following decompressive craniectomy in a single-center pediatric patient population with traumatic brain injury (TBI).
A retrospective review of data was performed using a prospectively acquired database of patients who underwent decompressive craniectomy at the authors' institution between January 1995 and April 2006. The patients' neuroimages were examined to evaluate the extent of intracranial injury, and the patients' records were reviewed to determine the admission Glasgow Coma Scale (GCS) score, the extent of systemic injuries, the time to craniectomy, and the indications for craniectomy. Long-term functional outcome and independence levels were evaluated using the Glasgow Outcome Scale (GOS) and a Likert patient quality-of-life rating scale. Twenty-three craniectomies were performed in children during the study period. The mean patient age at craniectomy was 11.9 years (range 2-19 years). In all patients, the computed tomography scans obtained at presentation revealed pathological findings, with diffuse axonal injury and traumatic contusions being the most common abnormalities. The median presenting GCS score was 4.6 (range 3-9). Nineteen patients (83%) suffered from other systemic injuries. One patient (4%) died intraoperatively and six patients (26%) died postoperatively. Postoperative intracranial pressure (ICP) control was obtained in 19 patients (83%); an ICP greater than 20 mm Hg was found to have the strongest correlation with subsequent brain death (p = 0.001). The mean follow-up duration was 63 months (range 11-126 months, median 49 months). The mean GOS score at the 2-year follow-up examination was 4.2 (median 5). At the most recent follow-up examination, 13 (81%) of 16 survivors had returned to school and only three survivors (18%) were dependent on caregivers.
Although the mortality rate for children with severe TBI remains high, decompressive craniectomy is effective in reducing ICP and is associated with good outcomes in surviving patients.
作者研究了单中心外伤性脑损伤（TBI）儿科患者行减压性颅骨切除术的指征及术后结果。
使用前瞻性收集的数据库对1995年1月至2006年4月在作者所在机构接受减压性颅骨切除术的患者数据进行回顾性分析。检查患者的神经影像以评估颅内损伤程度，并查阅患者记录以确定入院时的格拉斯哥昏迷量表（GCS）评分、全身损伤程度、颅骨切除时间及颅骨切除指征。使用格拉斯哥预后量表（GOS）和李克特患者生活质量评分量表评估长期功能结局和独立水平。研究期间对儿童进行了23次颅骨切除术。颅骨切除时患者的平均年龄为11.9岁（范围2 - 19岁）。所有患者就诊时的计算机断层扫描均显示有病理表现，弥漫性轴索损伤和创伤性挫伤是最常见的异常。就诊时GCS评分中位数为4.6（范围3 - 9）。19例患者（83%）伴有其他全身损伤。1例患者（4%）术中死亡，6例患者（26%）术后死亡。19例患者（83%）术后颅内压（ICP）得到控制；发现ICP大于20 mmHg与随后的脑死亡相关性最强（p = 0.001）。平均随访时间为63个月（范围11 - 126个月，中位数49个月）。2年随访检查时GOS评分平均为4.2（中位数5）。在最近一次随访检查时，16名幸存者中有13名（81%）已返校，仅有3名幸存者（18%）依赖照料者。
尽管重度TBI儿童的死亡率仍然很高，但减压性颅骨切除术在降低ICP方面有效，且与存活患者的良好结局相关。
