Hutchinson Peter, Timofeev Ivan, Kirkpatrick Peter
University of Cambridge Academic Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom.
Neurosurg Focus. 2007 May 15;22(5):E14. doi: 10.3171/foc.2007.22.5.15.
Brain edema is a common pathophysiological process seen in many neurosurgical conditions. It can be localized in relation to focal lesions or generalized in diffuse types of brain injury. In addition to local adverse effects occurring at a cellular level, brain edema is associated with raised intracranial pressure (ICP), and both phenomena contribute to poor outcome in patients. One of the goals in treating patients with acute neurosurgical conditions in intensive care is to control brain edema and maintain ICP below target levels. The mainstay of treatment is medical therapy to reduce edema, but in certain patients--for example, those with diffuse severe traumatic brain injury (TBI) and malignant middle cerebral artery infarction--such treatment is not effective. In these patients, opening the skull (decompressive craniectomy) to reduce ICP is a potential option. In this review the authors discuss the role of decompressive craniectomy as a surgical option in patients with brain edema in the context of a variety of pathological entities. They also address the current evidence for the technique (predominantly observational series) and the ongoing randomized studies of decompressive craniectomy in TBI and ischemic stroke.
脑水肿是许多神经外科疾病中常见的病理生理过程。它可局限于局灶性病变，也可在弥漫性脑损伤中呈全身性。除了在细胞水平上产生局部不良影响外，脑水肿还与颅内压（ICP）升高有关，这两种现象都会导致患者预后不良。重症监护中治疗急性神经外科疾病患者的目标之一是控制脑水肿并将颅内压维持在目标水平以下。治疗的主要方法是药物治疗以减轻水肿，但在某些患者中，例如弥漫性重度创伤性脑损伤（TBI）和恶性大脑中动脉梗死患者，这种治疗无效。在这些患者中，打开颅骨（减压性颅骨切除术）以降低颅内压是一种可能的选择。在这篇综述中，作者讨论了减压性颅骨切除术作为各种病理实体背景下脑水肿患者手术选择的作用。他们还阐述了该技术的现有证据（主要是观察性系列研究）以及正在进行的关于TBI和缺血性卒中减压性颅骨切除术的随机研究。
