重度颅脑损伤脑疝时应用小脑幕裂孔切开术的临床经验

Clinical experience of tentorium cerebelli hiatus incision in treatment of severe brain injury complicated from tentorial herniation

关键词:  重度颅脑损伤  颞叶钩回疝  小脑幕裂孔切开术

Key words:  severe brain injury  tentorial herniation  tentorium cerebelli hiatus incision

摘要:

［目的］探讨小脑幕裂孔切开术在救治重度颅脑损伤合并颞叶钩回疝的作用。［方法］对1999～2004年收治的23例重度颅脑损伤合并颞叶钩回疝继发脑干伤患者在开颅清除血肿去骨瓣的基础上加行小脑幕裂孔切开术。［结果］ GCS3～5分9例，6～8分14例，恢复良好12例（52.1%），中残5例（21.7%），重残3例（13.8%），植物生存1例（4.3%），死亡2例（8.7%）。［结论］ 小脑幕裂孔切开术有利于缓解颞叶钩回疝及继发脑干伤，降低病残率和死亡率。

Abstract:

［Objective］ To explore the effect of tentorium cerebelli hiatus incision of severe brain injury complicated from tentorial herniation.［Method］ Tentorium cerebelli hiatus incisions were made on the base of intracranial hematoma evacuation and bone flap craniotectomy decompression on 23 patients of severe braininjury with secondary brain stem injury resulted from tentorial herniation from 1999 to 2004. ［Result］Nine cases bad GCS score 3～5 and 14cases GCS 6～8.12cases (52.1%) survived well, 5 cases suffered from (21.7%) moderate disability, 3cases (13.8%) severe deficit, 1 cases (4.3%) vegetative and 102 cases (8.7%) death according to GCS. ［Conclusions］ Tentorium cerebelli hiatus incision could take effect on reducing secondary brain stem injury resulted from tentorial herniation and could bring down the disability and mortality of these patients.