Yatsushige Hiroshi, Takasato Yoshio, Masaoka Hiroyuki, Hayakawa Takanori, Otani Naoki, Yoshino Yoshikazu, Sumiyoshi Kyoko, Sugawara Takashi, Miyawaki Hiroki, Aoyagi Chikashi, Takeuchi Satoru, Suzuki Go
Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan.
Acta Neurochir Suppl. 2010;106:265-70. doi: 10.1007/978-3-211-98811-4_50.
Decompressive craniectomy for traumatic brain injury patients has been shown to reduce intracranial hypertension, while it often results in increased brain edema and/or contralateral space-occupied hematoma. The purpose of this study was to determine the prognosis of bilateral decompressive craniectomy in severe head injury patients with the development of either bilateral or contralateral lesions after ipsilateral decompressive craniectomy.
Twelve patients underwent bilateral decompressive craniectomy among 217 individuals who had been treated with decompressive craniectomy with dural expansion from September 1995 to August 2006. The following patient data were retrospectively collected: age, neurological status at admission, time between injury and surgical decompression, time between first and second decompression, laboratory and physiological data collected in the intensive care unit, and outcome according to the Glasgow Outcome Scale.
Patient outcomes fell into the following categories: good recovery (three patients); mild disability (one patient); severe disability (two patients); persistent vegetative state (one patient); and death (five patients). Patients with good outcomes were younger and had better pupil reactions and neurological statuses on admission. Other factors existing prior to the operation did not directly correlate with outcome. At 24 h post-surgery, the average intercranial pressure (ICP), cerebral perfusion pressure (CPP), glucose level, and lactate level in patients with poor outcomes differed significantly from those of patients with a good prognosis.
Head injury patients with either bilateral or contralateral lesions have poor prognosis. However, bilateral decompressive craniectomy may be a favorable treatment in certain younger patients with reactive pupils, whose ICP and CPP values are stabilized 24 h post-surgery.
已证实，对创伤性脑损伤患者进行去骨瓣减压术可降低颅内高压，但该手术常导致脑水肿加重和/或对侧占位性血肿形成。本研究的目的是确定在同侧去骨瓣减压术后出现双侧或对侧病变的重度颅脑损伤患者中，双侧去骨瓣减压术的预后情况。
在1995年9月至2006年8月期间接受硬脑膜扩张去骨瓣减压术治疗的217例患者中，有12例接受了双侧去骨瓣减压术。回顾性收集了以下患者数据：年龄、入院时的神经状态、受伤至手术减压的时间、首次和第二次减压的时间、重症监护病房收集的实验室和生理数据，以及根据格拉斯哥预后量表得出的结果。
患者的预后情况分为以下几类：恢复良好（3例）；轻度残疾（1例）；重度残疾（2例）；持续性植物状态（1例）；死亡（5例）。预后良好的患者年龄较小，入院时瞳孔反应和神经状态较好。术前存在的其他因素与预后无直接关联。术后24小时，预后不良患者的平均颅内压（ICP）、脑灌注压（CPP）、血糖水平和乳酸水平与预后良好的患者有显著差异。
患有双侧或对侧病变的颅脑损伤患者预后较差。然而，双侧去骨瓣减压术对于某些瞳孔有反应的年轻患者可能是一种有效的治疗方法，这些患者术后24小时的ICP和CPP值可保持稳定。
