Burkert W, Paver H D
Neurochirurgischen Abteilung des Bereichs Medizin der Martin-Luther-Universität Halle-Wittenberg.
Zentralbl Neurochir. 1988;49(4):318-23.
Already in 1905 and 1908 Harvey Cushing carried out decompression operations for the relieving of pressure in inoperable glious tumours and posttraumatic cerebral oedmas. This surgical method of trephination, which later-on was adopted by many other surgeons, was based on the method of the prevention of an incarceration of the mesencephalon in the tentorial slit by an enlargement of the reserve space in the interior of the crane. In case of a posttraumatic cerebral oedema, besides Heppner's work group practically all other authors operated in pronounced late stages of the incarceration. The results obtained were bad. Heppner worked on the basis of a wider indication, operated earlier, and obtained better results. The intervention should be performed on the basis of continuous preoperative measuring of the cerebral pressure. By means of calculations and modelling we were in a position to demonstrate that on both sides very large trephination areas with the relation of the radius of the trephination area to the radius of the head being 2 to 3 are necessary for achieving a sufficient decrease of the pressure by about 20 to 30 torr.
早在1905年和1908年，哈维·库欣就进行了减压手术，以缓解无法手术的胶质瘤和创伤后脑水肿所带来的压力。这种环锯术式的手术方法后来被许多其他外科医生采用，其依据是通过扩大颅腔内的储备空间来防止中脑嵌顿于小脑幕裂孔。对于创伤后脑水肿，除了赫普纳的研究团队外，几乎所有其他作者都是在嵌顿的明显晚期进行手术的，所获结果不佳。赫普纳的手术指征更宽泛，手术时机更早，结果更好。干预措施应基于术前对脑压的持续测量来进行。通过计算和建模，我们能够证明，为了使压力充分降低约20至30托，两侧需要有非常大的环锯区域，环锯区域半径与头部半径之比为2比3。
