Pechmann Astrid, Anastasopoulos Constantin, Korinthenberg Rudolf, van Velthoven-Wurster Vera, Kirschner Janbernd
Division of Neuropediatrics and Muscle Disorders, University Medical Center Freiburg, Freiburg, Germany.
Department of Neurosurgery, University Medical Center Freiburg, Freiburg, Germany.
Neuropediatrics. 2015 Feb;46(1):5-12. doi: 10.1055/s-0034-1393707. Epub 2014 Oct 24.
Decompressive craniectomy (DC) is a controversially discussed neurosurgical procedure to reduce elevated intracranial pressure after severe traumatic brain injury (TBI). In contrast to adults, several studies could show a benefit for the pediatric population, but still DC is considered as an emergency procedure only. The aim of our study was to identify secondary complications and long-term sequelae of the procedure. All children presenting to the University Medical Center Freiburg between 2005 and 2013 who underwent DC after severe TBI were retrospectively reviewed with respect to complications and outcome. Twelve children were included with a mean Glasgow Coma Scale of 4.5 ± 1.7. The most frequent complications after TBI and DC were formation of hygroma (83%), aseptic bone resorption of the reimplanted bone flap (50%), posttraumatic hydrocephalus (42%), secondary infection or dysfunction of ventriculoperitoneal shunt (25%) or cranioplasty (33%), and epilepsy (33%). Because of these complications, 75% of patients required further surgery in addition to cranioplasty with up to eight interventions. At follow-up, mean Glasgow Outcome Scale was 3.3 ± 1.2. Within our patient population, we demonstrated high incidence of complications after DC, leading to further surgical procedures and longer hospitalization. These potential complications have to be considered in any decision about DC as an emergency procedure.
去骨瓣减压术（DC）是一种在严重创伤性脑损伤（TBI）后用于降低颅内压升高的、存在争议的神经外科手术。与成人不同，多项研究表明该手术对儿童有益，但DC仍仅被视为一种紧急手术。我们研究的目的是确定该手术的继发性并发症和长期后遗症。对2005年至2013年间在弗莱堡大学医学中心因严重TBI接受DC手术的所有儿童进行回顾性研究，分析其并发症和预后情况。纳入12名儿童，平均格拉斯哥昏迷量表评分为4.5±1.7。TBI和DC术后最常见的并发症是形成蛛网膜下腔积液（83%）、再植入骨瓣的无菌性骨质吸收（50%）、创伤后脑积水（42%）、脑室腹腔分流管继发感染或功能障碍（25%）或颅骨修补术（33%）以及癫痫（33%）。由于这些并发症，75%的患者除颅骨修补术外还需要进一步手术，最多进行8次干预。随访时，平均格拉斯哥预后量表评分为3.3±1.2。在我们的患者群体中，我们证明了DC术后并发症的高发生率，这导致了进一步的手术和更长的住院时间。在任何关于将DC作为紧急手术的决策中，都必须考虑这些潜在并发症。
