头部计算机断层扫描成像上的颅骨骨折模式可预测创伤性脑损伤减压颅骨切除术后发生迟发性硬膜外血肿的风险。
Calvarial fracture patterns on CT imaging predict risk of a delayed epidural hematoma following decompressive craniectomy for traumatic brain injury.
作者信息
Talbott J F, Gean A, Yuh E L, Stiver S I
机构信息
From the Department of Radiology and Biomedical Imaging (J.F.T., A.G., E.L.Y.) Brain and Spine Injury Center (J.F.T., A.G., E.L.Y.), San Francisco General Hospital, San Francisco, California
From the Department of Radiology and Biomedical Imaging (J.F.T., A.G., E.L.Y.) Brain and Spine Injury Center (J.F.T., A.G., E.L.Y.), San Francisco General Hospital, San Francisco, California Department of Neurological Surgery (A.G., S.I.S.), University of California, San Francisco, California.
出版信息
AJNR Am J Neuroradiol. 2014 Oct;35(10):1930-5. doi: 10.3174/ajnr.A4001. Epub 2014 Jun 19.
BACKGROUND AND PURPOSE
The development of a delayed epidural hematoma as a result of decompressive craniectomy represents an urgent and potentially lethal complication in traumatic brain injury. The goal of this study was to determine the incidence of delayed epidural hematoma and whether patterns of skull fractures on the preoperative CT scan could predict risk of a delayed epidural hematoma.
MATERIALS AND METHODS
We retrospectively evaluated medical records and imaging studies for patients with acute traumatic brain injury who underwent a decompressive craniectomy during a 9-year period. We compared patterns of skull fractures contralateral to the side of the craniectomy with the occurrence of a postoperative delayed epidural hematoma.
RESULTS
In a series of 203 patients undergoing decompressive craniectomy for acute traumatic brain injury, the incidence of a delayed epidural hematoma complication was 6% (12 of 203). All 12 patients who developed a delayed epidural hematoma had a contralateral calvarial fracture on preoperative CT at the site where the delayed epidural hematoma subsequently formed. A contralateral calvarial fracture has perfect sensitivity (100%) for subsequent development of delayed epidural hematoma in our study population. Moreover, a contralateral calvarial fracture involving 2 or more bone plates had an especially high diagnostic odds ratio of 41 for delayed epidural hematoma.
CONCLUSIONS
Recognition of skull fracture patterns associated with delayed epidural hematoma following decompressive craniectomy may reduce morbidity and mortality by prompting early postoperative intervention in high-risk situations.
背景与目的
减压性颅骨切除术后发生迟发性硬膜外血肿是创伤性脑损伤中一种紧急且可能致命的并发症。本研究的目的是确定迟发性硬膜外血肿的发生率，以及术前CT扫描的颅骨骨折模式是否可预测迟发性硬膜外血肿的风险。
材料与方法
我们回顾性评估了在9年期间接受减压性颅骨切除术的急性创伤性脑损伤患者的病历和影像学研究。我们将颅骨切除术一侧对侧的颅骨骨折模式与术后迟发性硬膜外血肿的发生情况进行了比较。
结果
在一系列203例因急性创伤性脑损伤接受减压性颅骨切除术的患者中，迟发性硬膜外血肿并发症的发生率为6%（203例中的12例）。所有发生迟发性硬膜外血肿的12例患者在术前CT上，于迟发性硬膜外血肿随后形成的部位均有对侧颅骨骨折。在我们的研究人群中，对侧颅骨骨折对迟发性硬膜外血肿的后续发生具有完美的敏感性（100%）。此外，涉及2个或更多骨板的对侧颅骨骨折对于迟发性硬膜外血肿具有特别高的诊断优势比，为41。
结论
认识减压性颅骨切除术后与迟发性硬膜外血肿相关的颅骨骨折模式，可能通过在高危情况下促使早期术后干预来降低发病率和死亡率。
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