Crudele Angela, Shah Syed Omar, Bar Barak
Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
J Intensive Care Med. 2016 Oct;31(9):587-96. doi: 10.1177/0885066615601607. Epub 2015 Aug 31.
Increased intracranial pressure (ICP) secondary to severe brain injury is common. Increased ICP is commonly encountered in malignant middle cerebral artery ischemic stroke, traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage. Multiple interventions-both medical and surgical-exist to manage increased ICP. Medical management is used as first-line therapy; however, it is not always effective and is associated with significant risks. Decompressive hemicraniectomy is a surgical option to reduce ICP, increase cerebral compliance, and increase cerebral blood perfusion when medical management becomes insufficient. The purpose of this review is to provide an up-to-date summary of the use of decompressive hemicraniectomy for the management of refractory elevated ICP in malignant middle cerebral artery ischemic stroke, traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage.
严重脑损伤继发的颅内压（ICP）升高很常见。在恶性大脑中动脉缺血性卒中、创伤性脑损伤、蛛网膜下腔出血和脑出血中，颅内压升高也很常见。有多种医疗和手术干预措施可用于处理颅内压升高。药物治疗被用作一线治疗；然而，它并不总是有效，且伴有重大风险。当药物治疗不足时，去骨瓣减压术是一种降低颅内压、增加脑顺应性和增加脑血流灌注的手术选择。本综述的目的是提供关于去骨瓣减压术在恶性大脑中动脉缺血性卒中、创伤性脑损伤、蛛网膜下腔出血和脑出血中治疗难治性颅内压升高应用的最新总结。
