Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA.
Neurosurg Focus. 2010 May;28(5):E2. doi: 10.3171/2010.3.FOCUS1028.
Decompressive craniectomy (DC) with dural expansion is a life-saving neurosurgical procedure performed for recalcitrant intracranial hypertension due to trauma, stroke, and a multitude of other etiologies. Illustratively, we describe technique and lessons learned using DC for battlefield trauma.
Neurosurgical operative logs from service (October 2007 to September 2009) in Afghanistan that detail DC cases for trauma were analyzed. Illustrative examples of frontotemporoparietal and bifrontal DC that depict battlefield experience performing these procedures are presented with attention drawn to the L.G. Kempe hemispherectomy incision, brainstem decompression techniques, and dural onlay substitutes.
Ninety craniotomies were performed for trauma over the time period analyzed. Of these, 28 (31%) were DCs. Of the 28 DCs, 24 (86%) were frontotemporoparietal DCs, 7 (25%) were bifrontal DCs, and 2 (7%) were suboccipital DCs. Decompressive craniectomies were performed for 19 penetrating head injuries (13 gunshot wounds and 6 explosions) and 9 severe closed head injuries (6 war-related explosions and 3 others).
Thirty-one percent of craniotomies performed for trauma were DCs. Battlefield neurosurgeons use DC to allow for safe transfer of neurologically ill patients to tertiary military hospitals, which can be located 8-18 hours from a war zone. The authors recommend the L.G. Kempe incision for blood supply preservation, large craniectomies to prevent brain strangulation over bone edges, minimal brain debridement, adequate brainstem decompression, and dural onlay substitutes for dural closure.
去骨瓣减压术（DC）伴硬脑膜扩张术是一种用于治疗因创伤、中风和多种其他病因导致的顽固颅内高压的救命性神经外科手术。举例来说，我们描述了使用 DC 治疗战场创伤的技术和经验教训。
分析了阿富汗战场上（2007 年 10 月至 2009 年 9 月）的神经外科手术日志，其中详细记录了用于创伤的 DC 病例。我们展示了额颞顶枕部和额额部 DC 的典型病例，这些病例描绘了在战场上实施这些手术的经验，同时还注意到了 L.G. Kempe 半脑切除术切口、脑干减压技术和硬脑膜覆盖物替代品。
在所分析的时间段内，共进行了 90 例创伤性开颅手术。其中，28 例（31%）为 DC。在这 28 例 DC 中，24 例（86%）为额颞顶枕部 DC，7 例（25%）为额额部 DC，2 例（7%）为枕下部 DC。减压性颅骨切开术用于 19 例穿透性头部损伤（13 例枪伤和 6 例爆炸伤）和 9 例严重闭合性头部损伤（6 例与战争有关的爆炸伤和 3 例其他原因）。
31%的创伤性开颅手术为 DC。战场神经外科医生使用 DC 来安全地将患有神经疾病的患者转移到三级军事医院，这些医院距离战区可能有 8-18 小时的路程。作者建议使用 L.G. Kempe 切口以保留血供，进行大骨瓣切开术以防止颅骨边缘对脑组织的绞勒，进行最小限度的脑清创术，充分进行脑干减压术，并使用硬脑膜覆盖物替代品进行硬脑膜关闭。
