Chandankhede Abhijit Ravindra, Thombre Snehal D, Shukla Dhanwantari
Neurosurgery, Shree Siddheshwar Multispeciality Hospital, Dhule, IND.
Anesthesiology, Shree Siddheshwar Multispeciality Hospital, Dhule, IND.
Cureus. 2023 Jun 8;15(6):e40119. doi: 10.7759/cureus.40119. eCollection 2023 Jun.
Introduction Decompressive craniectomies have been performed in settings with raised intracranial pressure (ICP) after severe traumatic brain injury (TBI). A decompressive craniectomy (DC) is an important salvage procedure for intracranial hypertension. The changes in the intracranial microenvironment after a primary DC are significant in terms of the neurological outcome in the postoperative period. Materials and methods The study comprised 68 patients with severe TBIs who were undergoing primary DC; of these, 59% were male. Recorded data include demographic profiles, clinical features, and cranial computed tomography (CT) scans. All patients underwent a primary unilateral DC with augmentation duraplasty. Intracranial pressure was recorded in the first 24 hours at regular intervals, and the outcome was recorded using the Extended Glasgow Outcome Scale (GOS-E) at two-week and two-month intervals. Results Road traffic accidents (RTAs) are the most common cause of severe TBIs. Imaging studies and intraoperative findings suggest that acute subdural hematomas (SDHs) are the most common pathology leading to high ICP in the postoperative period. Mortality was strongly statistically associated with high ICP values postoperatively at all intervals. The average ICP for the patients who died was 11.871 mmHg higher than the patients who survived (p=0.0009). The Glasgow Coma Scale (GCS) at the time of admission is positively correlated with the neurological outcome at two weeks and two months, with a Pearson correlation coefficient of 0.4190 and 0.4235, respectively. There is a strong negative correlation between ICP in the postoperative period and the neurological outcome at two weeks and two months (Pearson correlation coefficients are -0.828 and -0.841, respectively). Conclusion The results indicate that RTAs are the most common cause of severe TBIs, and acute SDHs are the most common pathology leading to high ICP after the surgery. ICP values in the postoperative period have a strong negative correlation with survival and neurological outcome. Preoperative GCS and postoperative ICP monitoring are important methods of prognostication and planning further management.
引言 在严重创伤性脑损伤（TBI）后颅内压（ICP）升高的情况下，已实施去骨瓣减压术。去骨瓣减压术（DC）是治疗颅内高压的一项重要挽救性手术。初次DC术后颅内微环境的变化对术后神经功能结局具有重要意义。
材料与方法 本研究纳入了68例接受初次DC的重度TBI患者；其中59%为男性。记录的数据包括人口统计学资料、临床特征和头颅计算机断层扫描（CT）。所有患者均接受了初次单侧DC并同期行硬脑膜修补术。在术后24小时内定期记录颅内压，并在术后两周和两个月时使用扩展格拉斯哥预后量表（GOS-E）记录结局。
结果 道路交通事故（RTA）是重度TBI最常见的原因。影像学研究和术中发现提示，急性硬膜下血肿（SDH）是术后导致ICP升高最常见的病理情况。在所有时间点，死亡率与术后高ICP值在统计学上均有显著相关性。死亡患者的平均ICP比存活患者高11.871 mmHg（p = 0.0009）。入院时的格拉斯哥昏迷量表（GCS）与术后两周和两个月时的神经功能结局呈正相关，Pearson相关系数分别为0.4190和0.4235。术后ICP与术后两周和两个月时的神经功能结局呈强负相关（Pearson相关系数分别为-0.828和-0.841）。
结论 结果表明，RTA是重度TBI最常见的原因，急性SDH是术后导致高ICP最常见的病理情况。术后ICP值与生存率和神经功能结局呈强负相关。术前GCS和术后ICP监测是预后评估和规划进一步治疗的重要方法。
