Jasielski Piotr, Czernicki Zbigniew, Dąbrowski Piotr, Koszewski Waldemar, Rojkowski Rafał
Department of Neurosurgery, Bielanski Hospital, Warsaw, Poland.
Department of Neurosurgery, II Faculty of Medicine, Medical University of Warsaw, Poland.
Neurol Neurochir Pol. 2019;53(1):47-54. doi: 10.5603/PJNNS.a2018.0002. Epub 2019 Feb 11.
Decompressive craniectomy (DC) is a common neurosurgical procedure involving the removal of part of the skull vault combined with subsequent duroplasty. The goal of DC is to produce extra space for the swollen brain and/or to reduce intracranial pressure. In the present study, DC was performed in order to create space for the swollen brain.
to compare the volume alteration of selected intracranial fluid spaces before and after DC, to evaluate the volume of post-decompressive brain displacement (PDBD) and the largest dimension of oval craniectomy (LDOC), and to assess the early clinical effects of DC.
The study group consisted of 45 patients with traumatic brain injury (four females and 41 males, mean age 54.5 years) who underwent DC (not later than five hours after admission to hospital) due to subdural haematomas and/or haemorrhagic brain contusions localised supratentorially and diagnosed by computed tomography (CT). The mortality rate in the study group was 40%. Study calculations were performed using Praezis Plus software by Med Tatra, Zeppelin and Pax Station by Compart Medical Systems. For statistical analysis, IBM SPSS Statistics software was used.
The DC-related additional space was responsible for a statistically significant increase in the volume of preoperatively compressed intracranial fluid spaces. The mean volume of extra space filled by the swollen brain was 42.2 ml ± 40.7. The best early treatment results were achieved in patients under the age of 55.
DC has limited effectiveness in patients aged over 70 years. In every patient with clamped basal cisterns, a skin incision enabling appropriate LDOC should be planned before surgery. DC should be as large as possible, and the limits of its dimensions should be the limits of anatomical safety.
减压性颅骨切除术（DC）是一种常见的神经外科手术，包括切除部分颅骨穹窿并随后进行硬脑膜成形术。DC的目的是为肿胀的大脑创造额外空间和/或降低颅内压。在本研究中，进行DC是为了给肿胀的大脑创造空间。
比较DC前后选定颅内液腔的体积变化，评估减压后脑移位（PDBD）的体积和椭圆形颅骨切除术的最大尺寸（LDOC），并评估DC的早期临床效果。
研究组由45例创伤性脑损伤患者（4名女性和41名男性，平均年龄54.5岁）组成，这些患者因幕上硬膜下血肿和/或出血性脑挫伤接受DC（入院后不迟于5小时），并通过计算机断层扫描（CT）诊断。研究组的死亡率为40%。研究计算使用Med Tatra的Praezis Plus软件、Compart Medical Systems的Zeppelin和Pax Station进行。统计分析使用IBM SPSS Statistics软件。
与DC相关的额外空间导致术前受压颅内液腔体积有统计学意义的增加。肿胀大脑填充的额外空间平均体积为42.2 ml±40.7。55岁以下患者取得了最佳的早期治疗效果。
DC对70岁以上患者的有效性有限。对于每例基底池受压的患者，术前应规划一个能实现适当LDOC的皮肤切口。DC应尽可能大，其尺寸限制应为解剖学安全的限制。
