创伤性脑损伤减压性颅骨切除术术后的可逆性单瘫

Reversible monoparesis following decompressive hemicraniectomy for traumatic brain injury.

作者信息

Stiver Shirley I, Wintermark Max, Manley Geoffrey T

机构信息

Department of Neurosurgery, School of Medicine, University of California, San Francisco, California 94110-0899, USA.

出版信息

J Neurosurg. 2008 Aug;109(2):245-54. doi: 10.3171/JNS/2008/109/8/0245.

DOI:10.3171/JNS/2008/109/8/0245

PMID:18671636

Abstract

OBJECT

The "syndrome of the trephined" is an uncommon and poorly understood disorder of delayed neurological deficit following craniectomy. From the authors' extensive experience with decompressive hemicraniectomy for traumatic brain injury (TBI), they have encountered a number of patients who developed delayed motor deficits, also called "motor trephine syndrome," and reversal of the weakness following cranioplasty repair. The authors set out to study motor function systematically in this patient population to define the incidence, contributing factors, and outcome of patients with motor trephine syndrome.

METHODS

The authors evaluated patient demographics, injury characteristics, detailed motor examinations, and CT scans in 38 patients with long-term follow-up after decompressive hemicraniectomy for TBI.

RESULTS

Ten patients (26%) experienced delayed contralateral upper-extremity weakness, beginning 4.9 +/- 0.4 months (mean +/- standard error) after decompressive hemicraniectomy. Motor deficits improved markedly within 72 hours of cranioplasty repair, and all patients recovered full motor function. The CT perfusion scans, performed in 2 patients, demonstrated improvements in cerebral blood flow commensurate with resolution of cerebrospinal fluid flow disturbances on CT scanning and return of motor strength. Comparisons between 10 patients with and 20 patients (53%) without delayed motor deficits identified 3 factors--ipsilateral contusions, abnormal cerebrospinal fluid circulation, and longer intervals to cranioplasty repair--to be strongly associated with delayed, reversible monoparesis following decompressive hemicraniectomy.

CONCLUSIONS

Delayed, reversible monoparesis, also called motor trephine syndrome, is common following decompressive hemicraniectomy for TBI. The results of this study suggest that close follow-up of motor strength with early cranioplasty repair may prevent delayed motor complications of decompressive hemicraniectomy.

摘要

目的

“环锯综合征”是颅骨切除术后罕见且了解甚少的迟发性神经功能缺损疾病。根据作者在创伤性脑损伤（TBI）减压性颅骨切除术方面的丰富经验，他们遇到了一些出现迟发性运动功能缺损（也称为“运动环锯综合征”）以及颅骨成形术修复后肌无力逆转的患者。作者着手对这一患者群体的运动功能进行系统研究，以确定运动环锯综合征患者的发病率、相关因素及预后。

方法

作者评估了38例TBI减压性颅骨切除术后长期随访患者的人口统计学资料、损伤特征、详细的运动检查及CT扫描结果。

结果

10例患者（26%）出现迟发性对侧上肢无力，在减压性颅骨切除术后4.9±0.4个月（均值±标准误）开始出现。颅骨成形术修复后72小时内运动功能缺损明显改善，所有患者均恢复了完全运动功能。对2例患者进行的CT灌注扫描显示，脑血流量的改善与CT扫描显示的脑脊液流动障碍的缓解及运动力量的恢复相一致。对10例有迟发性运动功能缺损的患者和20例（53%）无迟发性运动功能缺损的患者进行比较，确定了3个因素——同侧挫伤、脑脊液循环异常以及颅骨成形术修复间隔时间较长——与减压性颅骨切除术后迟发性、可逆性单瘫密切相关。