选择性小儿患者创伤性后颅窝硬膜外血肿的环钻微创颅骨切除术
Trephination mini-craniectomy for traumatic posterior fossa epidural hematomas in selected pediatric patients.
作者信息
Sheng Han-Song, You Chao-Guo, Yang Liang, Zhang Nu, Lin Jian, Lin Fen-Chun, Wang Mao-De
机构信息
Department of Neurosurgery, First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, China; Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
出版信息
Chin J Traumatol. 2017 Aug;20(4):212-215. doi: 10.1016/j.cjtee.2017.01.004. Epub 2017 Jun 22.
PURPOSE
Posterior fossa epidural hematomas (PFEDH) are uncommon in children but usually require timely surgical intervention due to the risk of life-threatening brainstem compression. We attempt to make the surgical procedure less invasive by treating selected pediatric patients with trephination mini-craniectomy.
METHODS
We retrospectively reviewed the clinical courses, radiological findings, surgical procedures, and prognoses of the pediatric patients who were treated in our departments for traumatic PFEDH from January 2010 to January 2015.
RESULTS
During this period, a total of 17 patients were surgically treated for PFEDH and 7 were managed with trephination mini-craniectomy for hematoma evacuation. The outcomes were good in all 7 patients as evaluated with Glasgow Outcome Score. There was no mortality in this series. The on average 30-month clinical follow-up showed that patients experienced satisfactory recoveries without complications.
CONCLUSION
Our results suggest that trephination mini-craniectomy is a safe surgical technique for selected PFEDH patients with moderate hematoma volume and stabilized neurological functions. However, standard craniectomy is recommend when there are rapid deteriorations in patients' neurological functions or the hematomas are large and exerted severe mass effects.
目的
后颅窝硬膜外血肿（PFEDH）在儿童中并不常见，但由于存在危及生命的脑干受压风险，通常需要及时进行手术干预。我们试图通过对部分儿科患者采用环钻小骨窗开颅术，使手术创伤更小。
方法
我们回顾性分析了2010年1月至2015年1月在我院接受治疗的创伤性PFEDH儿科患者的临床病程、影像学表现、手术过程及预后。
结果
在此期间，共有17例患者接受了PFEDH手术治疗，其中7例采用环钻小骨窗开颅术清除血肿。根据格拉斯哥预后评分评估，所有7例患者预后良好。本系列无死亡病例。平均30个月的临床随访显示，患者恢复良好，无并发症。
结论
我们的结果表明，环钻小骨窗开颅术对于部分血肿量中等且神经功能稳定的PFEDH患者是一种安全的手术技术。然而，当患者神经功能迅速恶化或血肿较大且产生严重占位效应时，建议采用标准开颅术。
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