Saade Nelson, Veiga José Carlos Esteves, Cannoni Luiz Fernando, Haddad Luciano, Araújo João Luiz Vitorino
Department of Neurosurgery, Faculty of Medical Sciences, Irmandade da Santa Casa de Misericórdia de São Paulo.
Rev Col Bras Cir. 2014 Jul-Aug;41(4):256-62. doi: 10.1590/0100-69912014004006.
to determine predictive factors for prognosis of decompressive craniectomy in patients with severe traumatic brain injury (TBI), describing epidemiological findings and the major complications of this procedure.
we conducted a retrospective study based on analysis of clinical and neurological outcome, using the extended Glasgow outcome in 56 consecutive patients diagnosed with severe TBI scale treated in the emergency department from February 2004 to July 2012. The variables assessed were age, mechanism of injury, presence of pupillary changes, Glasgow coma scale (GCS) score on admission, CT scan findings (volume, type and association of intracranial lesions, deviation from the midline structures and classification in the scale of Marshall and Rotterdam).
we observed that 96.4% of patients underwent unilateral decompressive craniectomy (DC) with expansion duraplasty, and the remainder to bilateral DC, 53.6% of cases being on the right 42.9% on the left, and 3.6% bilaterally, with predominance of the fourth decade of life and males (83.9%). Complications were described as transcalvarial herniation (17.9%), increased volume of brain contusions (16.1%) higroma (16.1%), hydrocephalus (10.7%), swelling of the contralateral lesions (5.3%) and CSF leak (3.6%).
among the factors studied, only the presence of mydriasis with absence of pupillary reflex, scoring 4 and 5 in the Glasgow Coma Scale, association of intracranial lesions and diversion of midline structures (DML) exceeding 15 mm correlated statistically as predictors of poor prognosis.
确定重型颅脑损伤（TBI）患者减压性颅骨切除术预后的预测因素，描述该手术的流行病学结果及主要并发症。
我们进行了一项回顾性研究，基于对临床和神经学结果的分析，采用扩展格拉斯哥预后量表对2004年2月至2012年7月在急诊科治疗的56例连续诊断为重型TBI的患者进行评估。评估的变量包括年龄、损伤机制、瞳孔变化情况、入院时格拉斯哥昏迷量表（GCS）评分、CT扫描结果（颅内病变的体积、类型及合并情况、中线结构偏移以及马歇尔和鹿特丹量表分类）。
我们观察到96.4%的患者接受了单侧减压性颅骨切除术（DC）并进行硬膜扩大修补术，其余患者接受双侧DC，53.6%的病例在右侧，42.9%在左侧，3.6%为双侧，以40岁左右人群及男性为主（83.9%）。并发症包括经颅骨疝（17.9%）、脑挫伤体积增加（16.1%）、硬脑膜下积液（16.1%）、脑积水（10.7%）、对侧病变肿胀（5.3%）和脑脊液漏（3.6%）。
在所研究的因素中，只有瞳孔散大且无瞳孔反射、格拉斯哥昏迷量表评分为4分和5分、颅内病变合并以及中线结构偏移（DML）超过15 mm在统计学上与预后不良相关，可作为预后不良的预测指标。
