早期第三脑室底造瘘术联合颅骨修补术治疗外伤性脑积水合并颅骨缺损的临床疗效
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摘要
目的探讨早期一次性第三脑室底造瘘术联合颅骨修补术在外伤性脑积水(PTH)合并颅骨缺损治疗中的作用。方法回顾性分析2013年8月—2018年12月同期行第三脑室底造瘘术及颅骨修补术的颅脑外伤病例15例,对其临床资料、并发症及预后等数据进行总结。结果该组手术时机均选在颅脑外伤后3个月内,术后并发颅骨修补切口愈合不良并皮下积液1例,2例效果不佳行脑室-腹腔分流术。恢复良好6例(40.00%),中残7例(46.7%),重残2例(13.3%),无死亡病例。结论神经内镜下第三脑室底造瘘术(ETV)符合脑脊液循环生理学特点,创伤相对小,并发症更少,早期联合颅骨修补术是治疗外伤性脑积水合并颅骨缺损的有效方法。
Objective To investigate the role of early disposable third ventriculostomy combined with cranioplasty in the treatment of traumatic hydrocephalus(PTH) with skull defect. Methods A retrospective analysis of 15 cases of craniocerebral trauma with third ventriculostomy and cranioplasty from August 2013 to December 2018 was performed. The clinical data, complications and prognosis were summarized. Results The operation time of this group was selected within 3 months after craniocerebral trauma. The postoperative craniotomy was used to repair the incision and the subcutaneous effusion was poor. In 2 cases, the ventricle-peritoneal shunt was performed with poor results; 6 cases(40.0%) with good recovery, 7 cases(46.7%) with moderate disability, and 2 cases(13.3%) with severe disability. There were no deaths. Conclusion Endoscopic third ventriculostomy(ETV) is consistent with the physiology of cerebrospinal fluid circulation. The trauma is relatively small and the complications are less. Early combined with cranioplasty is an effective method for the treatment of traumatic hydrocephalus with skull defect.
Objective To investigate the role of early disposable third ventriculostomy combined with cranioplasty in the treatment of traumatic hydrocephalus(PTH) with skull defect. Methods A retrospective analysis of 15 cases of craniocerebral trauma with third ventriculostomy and cranioplasty from August 2013 to December 2018 was performed. The clinical data, complications and prognosis were summarized. Results The operation time of this group was selected within 3 months after craniocerebral trauma. The postoperative craniotomy was used to repair the incision and the subcutaneous effusion was poor. In 2 cases, the ventricle-peritoneal shunt was performed with poor results; 6 cases(40.0%) with good recovery, 7 cases(46.7%) with moderate disability, and 2 cases(13.3%) with severe disability. There were no deaths. Conclusion Endoscopic third ventriculostomy(ETV) is consistent with the physiology of cerebrospinal fluid circulation. The trauma is relatively small and the complications are less. Early combined with cranioplasty is an effective method for the treatment of traumatic hydrocephalus with skull defect.
引文
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[2]中华神经外科分会神经创伤专业组,中华创伤学会分会神经创伤专业组.颅脑创伤后脑积水诊治中国专家共识[J]中华神经外科杂志,2014,30(8):840-843.
[3]隋宇玲.早期脑室分流及颅骨修补治疗颅脑外伤术后脑积水的研究[J].中国现代药物应用,2018,12(3):36-37.
[4]匡柏成,钱晟,刘宗霖,等.同期腰大池-腹腔分流术联合颅骨成形术治疗去骨瓣减压术后交通性脑积水[J].中国临床神经外科杂,2018,23(9):615-617.
[5]刘华,漆松涛,彭玉平,等.神经内镜下第三脑室底造瘘术治疗交通性脑积水[J].中华神经外科杂志,2013,29(4):387-389.
[6]王国权,李晓玲,齐云鹏.早期脑室-腹腔分流术同期采用颅骨修补术对脑外伤伴脑积水治疗效果评价[J].中国现代药物应用,2017,11(23):35-36.
[7]杨恒,刘窗溪.脑室腹腔分流术后脑积水患者再次行神经内镜下三脑室底造瘘的疗效评价[J].中国内镜杂志,201824(12):61-66.
[8]张建斌,黄齐兵,纪延伟,等.去骨瓣减压术后脑积水的治疗策略及手术并发症的分析[J].中华神经外科杂志,2016,32(10):1029-1033.
[9]潘宝根,董策,楚宝,等.神经内镜第三脑室底造瘘术联合脉络丛烧灼术治疗脑积水的疗效分析[J].中国微侵袭神经外科杂志,2018.23(12):543-546.
[10]吴震,卜雄建.神经内镜治疗成人正压性脑积水的临床应用[J].中国临床研究,2017.30(10):1359-1361.
[11]赵礼彬,曾琴.脑室-腹腔分流术治疗重型脑外伤术后脑积水疗效及相关因素分析[J].中国实用神经疾病杂志,201619(4):35-36.
[12]董策,潘宝根,明星,等.神经内镜第三脑室底造瘘术治疗蛛网膜下腔出血后脑积水的疗效分析[J].中华神经外科杂志,2018,34(2):180-183.
[13]Ragheb,John Bhatia,Sanjiv Chamiraju,et al.Endoscopic third ventriculostomy and choroid plexus cauterization with a rigid neuroendoscope in infants with hydrocephalus[J].Jour nal of neurosurgery Pediatrics,2016,17(2):163-173.