Jiang Yun-Zhao, Lan Qing, Wang Qi-Hong, Song Dong-Lei, Lu Hua, Wu Wei-Jiang
Department of Neurosurgery, Wuxi Third People's Hospital, 585# Xingyuan Road, Wuxi, 214041, Jiangsu, People's Republic of China.
Cell Biochem Biophys. 2014 Jul;69(3):461-6. doi: 10.1007/s12013-014-9818-6.
Patients suffering from uncontrollable intracranial hypertension due to posttraumatic brain swelling (BS) generally either die or survive in an extremely disabled state. Decompressive craniectomy (DC) with dural augmentation may be the best method to assist these patients. However, the efficacy of DC on functional outcomes remains controversial. One of the factors contributing to poor outcomes could be intraoperative brain extrusion, which is an acute potential complication of DC. The authors have adopted a new surgical technique for traumatic BS that can prevent and control massive intraoperative BS (IOS). In the past 3 years, the authors have used a unique technique, called "gradual and controlled decompression", in the treatment of posttraumatic BS. This procedure consists of creating numerous small dural openings and removing clots; enlarging fenestration in the frontal and temporal basal regions to detect and treat brain contusion; making U-shaped, discontinuous, small dural incisions around the circumference of the craniotomy; and performing an augmentation duraplasty through the discontinuous small opening with dural prosthetic substances. This technique has been employed in 23 patients suffering from posttraumatic BS. In all cases, IOS was prevented and controlled through gradual stepwise decompression, and expanded duraplasty was performed successfully. This new surgical approach for posttraumatic BS can prevent severe extrusion of the brain through the craniotomy defect and allows the gradual and gentle release of the subdural space. Further clinical studies should be conducted to estimate the impact of this new technique on morbidity and mortality rates.
因创伤后脑肿胀（BS）导致颅内压无法控制的患者通常不是死亡，就是存活下来但处于极度残疾状态。带硬脑膜增强的减压性颅骨切除术（DC）可能是帮助这些患者的最佳方法。然而，DC对功能结局的疗效仍存在争议。导致不良结局的因素之一可能是术中脑膨出，这是DC的一种急性潜在并发症。作者采用了一种新的创伤性BS手术技术，可预防和控制术中大量脑肿胀（IOS）。在过去3年中，作者使用了一种独特的技术，称为“逐步控制性减压”，用于治疗创伤性BS。该手术包括制造多个小的硬脑膜开口并清除血块；扩大额颞底部区域的开窗以检测和治疗脑挫伤；在开颅手术周边制作U形、不连续的小硬脑膜切口；以及通过带有硬脑膜修复材料的不连续小开口进行硬脑膜扩大修补术。该技术已应用于23例创伤性BS患者。在所有病例中，通过逐步减压预防和控制了IOS，并成功进行了扩大硬脑膜修补术。这种创伤性BS的新手术方法可防止脑通过开颅缺损严重膨出，并允许逐渐轻柔地释放硬膜下间隙。应进行进一步的临床研究，以评估这种新技术对发病率和死亡率的影响。
