Stula D
Neurochirurgia (Stuttg). 1985 Jul;28(4):164-9. doi: 10.1055/s-2008-1054190.
We measured the intracranial pressure continuously for a period of four days before and after cranioplasty in 12 patients with skull defects larger than 100 cm2. The results were obtained by epidural monitoring. The device used was the "Hellige" pressure measuring device (modified according to Gobiet). We found an increased cranial pressure in more than half of the patients (7). In addition the same patients showed the most marked neurologic and psychic changes. A significant return to normal of the intracranial pressure was noticed in all these patients after the closure of the skull defect. Progressive improvement in the clinical symptoms was also seen. The pathogenesis of this phenomenon has not been completely explained. Several authors consider that an important factor is the difference between the intracranial and the atmospheric pressure, However, we suggest that another important factor is the cicatricial changes ("scar plate") occurring between the cortex, dura and the skin, which exerts pressure on the skull contents. Previously, the neurological symptoms which appeared after a period of time in patients with large skull defects were attributed to other causes. It is only during the past decades--thanks to progress in neuroradiologic diagnostics--that a pathoanatomical correlate been found for these changes.
我们对12例颅骨缺损面积大于100平方厘米的患者在颅骨修补术前和术后连续四天测量颅内压。结果通过硬膜外监测获得。使用的设备是“Hellige”压力测量装置（根据戈比埃进行了改进）。我们发现超过一半的患者（7例）颅内压升高。此外，这些患者还表现出最明显的神经和精神变化。在颅骨缺损闭合后，所有这些患者的颅内压均显著恢复正常。临床症状也有逐渐改善。这种现象的发病机制尚未完全阐明。几位作者认为一个重要因素是颅内压与大气压之间的差异。然而，我们认为另一个重要因素是在皮质、硬脑膜和皮肤之间发生的瘢痕性变化（“瘢痕板”），它对颅内内容物施加压力。以前，颅骨大缺损患者在一段时间后出现的神经症状被归因于其他原因。只是在过去几十年里——由于神经放射诊断学的进展——才发现了这些变化的病理解剖学关联。
