重度创伤性脑损伤外科治疗的当前观点
Current Perspectives in the Surgical Treatment of Severe Traumatic Brain Injury.
作者信息
Giammattei Lorenzo, Messerer Mahmoud, Cherian Iype, Starnoni Daniele, Maduri Rodolfo, Kasper Ekkehard M, Daniel Roy T
机构信息
Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland.
Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland.
出版信息
World Neurosurg. 2018 Aug;116:322-328. doi: 10.1016/j.wneu.2018.05.176. Epub 2018 Jun 1.
BACKGROUND
The available surgical options to control increased intracranial pressure and to limit secondary brain damage in the setting of severe traumatic brain injury (TBI) include decompressive craniectomy, cisternostomy, and other methods to divert cerebrospinal fluid (CSF) such as placement of an external ventricular drain.
METHODS
We discuss the rationale and the limitations of these surgical techniques based on preclinical and clinical evidence. A detailed description of the differences between ventricular CSF drainage and cisternal drainage is added based on recent hypotheses on TBI physiopathology and CSF circulation.
RESULTS
Cisternostomy seems a more physiological approach to the treatment of brain swelling, with the potential of effectively controlling intracranial pressure and reducing the effects of secondary brain damage.
CONCLUSIONS
Further clinical studies need to be performed to validate the efficacy of this emerging surgical procedure for severe TBI.
背景
在严重创伤性脑损伤（TBI）的情况下，用于控制颅内压升高和限制继发性脑损伤的现有手术选择包括减压颅骨切除术、脑池造瘘术以及其他引流脑脊液（CSF）的方法，如放置外部脑室引流管。
方法
我们基于临床前和临床证据讨论这些手术技术的原理和局限性。根据最近关于TBI生理病理学和CSF循环的假说，详细描述了脑室CSF引流和脑池引流之间的差异。
结果
脑池造瘘术似乎是治疗脑肿胀的一种更符合生理的方法，有可能有效控制颅内压并减轻继发性脑损伤的影响。
结论
需要进行进一步的临床研究以验证这种新兴手术方法对严重TBI的疗效。
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