Han Tangrui, Jia Zhiqiang, Zhang Xiaokai, Wu Hao, Li Qiang, Cheng Shiqi, Zhang Yan, Wang Yonghong
Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China.
Department of Neurosurgery, First Hospital of Shanxi Medical University, Taiyuan, 030001, China.
Chin J Traumatol. 2025 Mar;28(2):118-123. doi: 10.1016/j.cjtee.2024.09.007. Epub 2024 Nov 20.
Traumatic brain injury (TBI) is a significant public health issue that impacts individuals all over the world and is one of the main causes of mortality and morbidity. Decompressive craniectomy is the usual course of treatment. Basal cisternostomy has been shown to be highly effective as an alternative procedure to decompressive craniectomy.
We conducted a retrospective cohort of patients who received surgery for severe TBI between January 2019 and March 2023. Inclusion criterias were patients between the ages of 18 and 70 years who met the diagnostic criteria for severe TBI at first presentation and who underwent surgical intervention. The exclusion criteria were patients who have severe multiple injuries at the time of admission; preoperative intracranial pressure > 60 mmHg; cognitive impairment before the onset of the disease; hematologic disorders; or impaired functioning of the heart, liver, kidneys, or other visceral organs. Depending on the surgical approach, the patients were categorized into decompressive craniectomy group as well as basal cisternostomy group. General data and postoperative indicators, including Glasgow coma scale, intracranial pressure, etc., were recorded for both groups of patients. Among them, the Glasgow outcome scale extended assessment at 6 months served as the primary outcome. After that, the data were statistically analyzed using SPSS software.
The trial enrolled 41 patients (32 men and 9 women) who met the inclusion criteria. Among them, 25 patients received decompressive decompressive craniectomy, and 16 patients received basal cisternostomy. Three days postoperative intracranial pressure levels were 10.07 ± 2.94 mmHg and 17.15 ± 14.65 mmHg (p = 0.013), respectively. The 6 months following discharge Glasgow outcome scale extended of patients was 4.73 ± 2.28 and 3.14 ± 2.15 (p = 0.027), respectively.
Our study reveals that basal cisternostomy in patients with surgically treated severe TBI has demonstrated significant efficacy in reducing intracranial pressure as well as patient prognosis follow-up and avoids removal of the bone flap. The efficacy of cisternostomy has to be studied in larger, multi-clinical center randomized trials.
创伤性脑损伤（TBI）是一个重大的公共卫生问题，影响着全世界的个人，是死亡和发病的主要原因之一。去骨瓣减压术是常用的治疗方法。基底池造瘘术已被证明作为去骨瓣减压术的替代手术非常有效。
我们对2019年1月至2023年3月期间接受严重TBI手术的患者进行了一项回顾性队列研究。纳入标准为年龄在18至70岁之间、首次就诊时符合严重TBI诊断标准且接受手术干预的患者。排除标准为入院时患有严重多发伤的患者；术前颅内压>60 mmHg；疾病发作前有认知障碍；血液系统疾病；或心脏、肝脏、肾脏或其他内脏器官功能受损。根据手术方式，将患者分为去骨瓣减压术组和基底池造瘘术组。记录两组患者的一般资料和术后指标，包括格拉斯哥昏迷量表、颅内压等。其中，6个月时的格拉斯哥预后量表扩展评估作为主要结局。之后，使用SPSS软件对数据进行统计分析。
该试验纳入了41例符合纳入标准的患者（32例男性和9例女性）。其中，25例患者接受了去骨瓣减压术，16例患者接受了基底池造瘘术。术后三天颅内压水平分别为10.07±2.94 mmHg和17.15±14.65 mmHg（p = 0.013）。出院后6个月患者的格拉斯哥预后量表扩展评分分别为4.73±2.28和3.14±2.15（p = 0.027）。
我们的研究表明，对于接受手术治疗的严重TBI患者，基底池造瘘术在降低颅内压以及患者预后随访方面显示出显著疗效，并且避免了骨瓣切除。造瘘术的疗效有待在更大规模的多临床中心随机试验中进行研究。
