Katayama Y, Tsubokawa T, Miyazaki S, Kawamata T, Yoshino A
Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
Acta Neurochir Suppl (Wien). 1990;51:308-10. doi: 10.1007/978-3-7091-9115-6_104.
In patients with focal cerebral contusions, medical therapies have generally been advocated unless haemorrhages significantly contributing to the elevated intracranial pressure (ICP) exist. We report here several lines of clinical evidence which indicate that (1) enormous amount of extracellular oedema fluid is formed within contused brain tissue, (2) the formation of extracellular oedema fluid within contused brain tissue alone can be a cause of medically uncontrollable elevation of ICP and (3) surgical excision of the contused brain tissue provides excellent control of the elevated ICP in such patients. The excision of contused brain tissue appears to be the only therapy currently available to alleviate the formation of extracellular oedema fluid in cerebral contusions. We believe that, if ICP is elevated primarily by extracellular oedema due to cerebral contusions and the elevated ICP is medically uncontrollable, surgical excision of contused brain tissue should be carried out without delay regardless of the size of associated haemorrhages.
对于局灶性脑挫伤患者，一般主张采用内科治疗，除非存在显著导致颅内压（ICP）升高的出血情况。我们在此报告几条临床证据，这些证据表明：（1）在挫伤的脑组织内会形成大量细胞外水肿液；（2）仅挫伤脑组织内细胞外水肿液的形成就可能是导致内科无法控制的ICP升高的原因；（3）手术切除挫伤的脑组织能很好地控制此类患者升高的ICP。切除挫伤的脑组织似乎是目前唯一可用于减轻脑挫伤中细胞外水肿液形成的治疗方法。我们认为，如果ICP主要因脑挫伤导致的细胞外水肿而升高，且升高的ICP在内科治疗下无法控制，那么无论相关出血的大小如何，都应立即进行手术切除挫伤的脑组织。
