Araujo Junior Antonio Santos de, Arlant Pedro Alberto, Salvestrini Arnaldo, Altieri Carlos Eduardo, Santos Jasper Guimarães, Pinto Lauro Figueira, Fazzito Mirella Martins, Lee Hae Won, Godoy Luis Felipe de Souza
Hospital Sírio-Libanês, Brazil, Sao PauloSP.
Arq Neuropsiquiatr. 2013 Dec;71(12):963-6. doi: 10.1590/0004-282X20130176.
Decompressive craniectomy (DC) is gaining an increasing role in the neurosurgical treatment of intractable intracranial hypertension, but not without complications. A rare complication is the "syndrome of the trephined" (ST). It occurs when the forces of gravity overwhelm intracranial pressures, leading the brain to become sunken.
To determine the usefulness of asymmetric optic nerve sheath diameter (ONSD) as an outcome factor after cranioplasty.
We followed-up 5 patients submitted to DC and diagnosed with ST. All were submitted to brain MRI to calculate the ONSD.
Only two patients presented an asymmetric ONSD, being ONSD larger at the site of craniectomy. Surprisingly these patients had a marked neurological improvement after cranioplasty. They became independent a week after and statistically earlier than others.
It is presumed that the presence of an asymmetric ONSD in trephined patients is an independent factor of good outcome after cranioplasty.
减压性颅骨切除术（DC）在难治性颅内高压的神经外科治疗中发挥着越来越重要的作用，但并非没有并发症。一种罕见的并发症是“去骨瓣减压综合征”（ST）。当重力超过颅内压时就会发生这种情况，导致脑内陷。
确定颅骨修补术后不对称视神经鞘直径（ONSD）作为预后因素的有用性。
我们对5例行DC并诊断为ST的患者进行了随访。所有患者均接受脑部MRI检查以计算ONSD。
只有两名患者出现不对称ONSD，在颅骨切除部位ONSD较大。令人惊讶的是，这些患者在颅骨修补术后神经功能有明显改善。他们在一周后能够独立，且在统计学上比其他患者更早。
据推测，去骨瓣减压患者中存在不对称ONSD是颅骨修补术后良好预后的独立因素。
