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中华神经创伤外科电子杂志 ›› 2017, Vol. 03 ›› Issue (03) : 179 -184. doi: 10.3877/cma.j.issn.2095-9141.2017.03.013

所属专题: 文献

综述

去骨瓣减压术后脑脊液动力学障碍
冯毅1, 杨理坤1, 王玉海1,()   
  1. 1. 214044 无锡,解放军一零一医院神经外科全军颅脑创伤救治中心
  • 收稿日期:2017-04-04 出版日期:2017-06-15
  • 通信作者: 王玉海

Cerebrospinal fluid dynamics disorder after decompressive craniectomy

Yi Feng1, Likun Yang1, Yuhai Wang1,()   

  1. 1. Department of Neurosurgery, Army TBI Center, the 101st Hospital of PLA, Wuxi 214044, China
  • Received:2017-04-04 Published:2017-06-15
  • Corresponding author: Yuhai Wang
  • About author:
    Correspondingauthor: Wang Yuhai, Email:
引用本文:

冯毅, 杨理坤, 王玉海. 去骨瓣减压术后脑脊液动力学障碍[J]. 中华神经创伤外科电子杂志, 2017, 03(03): 179-184.

Yi Feng, Likun Yang, Yuhai Wang. Cerebrospinal fluid dynamics disorder after decompressive craniectomy[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2017, 03(03): 179-184.

脑脊液是持续搏动的,其搏动性在去骨瓣后受到影响,造成脑脊液吸收和分布障碍,从而造成神经症状,称为脑脊液动力学障碍。笔者根据文献将其归类为环锯综合征(SoT)、反常性脑疝、脑积水和硬膜下积液。SoT表现为患者在去骨瓣后皮瓣下陷的同时产生了一系列神经功能减退现象;反常性脑疝是前者的加重,往往和脑脊液引流、过度脱水等有关。脑积水、硬膜下积液也是去骨瓣的常见并发症。上述疾病首选的、最终治疗方法都是颅骨修补。脑脊液分布异常时,不当的脑脊液引流可加重病情并引起严重后果。

Continuous pulsation of cerebrospinal fluid (CSF) is impaired after decompressive craniectomy (DC), inducing disturbances of CSF absorption and distribution, consequently, neurological symptoms, which are called CSF dynamics disorders. acrrodingThey are classified into for types: syndrome of the trephined (SoT), paradoxical herniation, hydrocephalus and subdural collection of fluid. SoT is indentified by neurological deficits after DC, paradoxical herniation is an aggravating form of syndrome of SoT, commonly in connection with CSF drainage and excessive dehydration. Hydrocephalus and subdural collection of fluid, are common consequences after DC. Cranioplasty is the most preferred and definitive therapy of above four complications, impropriate drainage towards CSF distribution abnormality will worsen the condition, causing serious consequences.

图1 环锯综合征的影像学表现
图2 脑积水和硬膜下积液进行不恰当的引流引发反常性脑疝的影像学资料
表1 脑外伤后硬膜下液体积聚的分类
图3 对侧型硬膜下积液的影像学表现
图4 脑外积液(箭头所示)的影像学表现
[1]
Grant FC, Norcross NC. Repair of cranial defects by cranioplasty[J]. Ann Surg, 1939, 110(4): 488-512.
[2]
Yamaura A, Makino H. Neurological deficits in the presence of the sinking skin flap following decompressive craniectomy[J]. Neurol Med Chir (Tokyo), 1977, 17(1 Pt 1): 43-53.
[3]
Yamamura A, Makino H. Neurologic deficit following craniectomy[J]. J Neurosurg, 1976, 45: 362
[4]
Fodstad H, Love JA, Ekstedt J, et al. Effect of cranioplasty on cerebrospinal fluid hydrodynamics in patients with the syndrome of the trephined[J]. Acta Neurochir (Wien), 1984, 70(1-2): 21-30.
[5]
Ashayeri K, M Jackson E, Huang J, et al. Syndrome of the Trephined: A Systematic Review[J]. Neurosurgery, 2016, 79(4): 525-534.
[6]
Dujovny M, Fernandez P, Alperin N, et al. Post-cranioplasty cerebrospinal fluid hydrodynamic changes: magnetic resonance imaging quantitative analysis[J]. Neurol Res, 1997, 19(3): 311-316.
[7]
Picard NA, Zanardi CA. Brain motion in patients with skull defects: B-mode ultrasound observations on respiration-induced movements[J]. Acta Neurochir (Wien), 2013, 155(11): 2149-2157.
[8]
Dujovny M, Agner C, Aviles A. Syndrome of the trephined: theory and facts[J]. Crit Rev Neurosurg, 1999, 9(5): 271-278.
[9]
Richaud J, Boetto S, Guell A, et al. Effects of cranioplasty on neurological function and cerebral blood flow[J]. Neurochirurgie, 1985, 31(3): 183-188.
[10]
Tabaddor K, LaMorgese J. Complication of a large cranial defect. Case report[J]. J Neurosurg, 1976, 44(4): 506-508.
[11]
Stula D. Intracranial pressure measurement in large skull defects[J]. Neurochirurgia (Stuttg), 1985, 28(4): 164-169.
[12]
Schwab S, Erbguth F, Aschoff A, et al. "Paradoxical" herniation after decompressive trephining[J]. Nervenarzt, 1998, 69(10): 896-900.
[13]
吴晋,杨应明.去大骨瓣减压术后反常性脑疝研究进展[J].汕头大学医学院学报, 2012, 25(4): 230-232.
[14]
Fields JD, Lansberg MG, Skirboll SL, et al. "Paradoxical" transtentorial herniation due to CSF drainage in the presence of a hemicraniectomy[J]. Neurology, 2006, 67(8): 1513-1514.
[15]
Rahme R, Bojanowski MW. Overt cerebrospinal fluid drainage is not a sine qua non for paradoxical herniation after decompressive craniectomy: case report[J]. Neurosurgery, 2010, 67(1): 214-215; discussion 215.
[16]
Choi JJ, Cirivello MJ, Neal CJ, et al. Paradoxical herniation in wartime penetrating brain injury with concomitant skull-base trauma[J]. J Craniofac Surg, 2011, 22(6): 2163-2167.
[17]
Feng Y, Wang Y. Coexistent of paradoxical herniation and subdural hygroma: a case report[J]. Chinese Neurosurgical Journal, 2015, 1(1): 11.
[18]
Segal DH, Oppenheim JS, Murovic JA. Neurological recovery after cranioplasty[J]. Neurosurgery, 1994, 34(4): 729-731; discussion 731.
[19]
Schiffer J, Gur R, Nisim U, et al. Symptomatic patients after craniectomy[J]. Surg Neurol, 1997, 47(3): 231-237.
[20]
中国医师协会神经外科医师分会.中国脑积水规范化治疗专家共识(2013版)[J].中华神经外科杂志, 2013, 29(6): 634-637.
[21]
Guyot LL, Michael DB. Post-traumatic hydrocephalus[J]. Neurol Res, 2000, 22(1): 25-28.
[22]
Stiver SI. Complications of decompressive craniectomy for traumatic brain injury[J]. Neurosurg Focus, 2009, 26(6): E7.
[23]
Mazzini L, Campini R, Angelino E, et al. Posttraumatic hydrocephalus: a clinical, neuroradiologic, and neuropsychologic assessment of long-term outcome[J]. Arch Phys Med Rehabil, 2003, 84(11): 1637-1641.
[24]
Choi I, Park HK, Chang JC, et al. Clinical factors for the development of posttraumatic hydrocephalus after decompressive craniectomy[J]. J Korean Neurosurg Soc, 2008, 43(5): 227-231.
[25]
Shi SS, Zhang GL, Zeng T, et al. Posttraumatic hydrocephalus associated with decompressive cranial defect in severe brain-injured patients[J]. Chin J Traumatol, 2011, 14(6): 343-347.
[26]
Waziri A, Fusco D, Mayer SA, et al. Postoperative hydrocephalus in patients undergoing decompressive hemicraniectomy for ischemic or hemorrhagic stroke[J]. Neurosurgery, 2007, 61(3): 489-493; discussion 493-494.
[27]
Welch K, Friedman V. The cerebrospinal fluid valves[J]. Brain, 1960, 83: 454-469.
[28]
De Bonis P, Pompucci A, Mangiola A, et al. Post-traumatic hydrocephalus after decompressive craniectomy: an underestimated risk factor[J]. J Neurotrauma, 2010, 27(11): 1965-1970.
[29]
Anile C, De Bonis P, Di Chirico A, et al. Cerebral blood flow autoregulation during intracranial hypertension: a simple, purely hydraulic mechanism[J]? Childs Nerv Syst, 2009, 25(3): 325-335; discussion 337-340.
[30]
Akins PT, Guppy KH. Sinking skin flaps, paradoxical herniation, and external brain tamponade: a review of decompressive craniectomy management[J]. Neurocrit Care, 2008, 9(2): 269-276.
[31]
Poca MA, Sahuquillo J, Mataro M, et al. Ventricular enlargement after moderate or severe head injury: a frequent and neglected problem[J]. J Neurotrauma, 2005, 22(11): 1303-1310.
[32]
Marmarou A, Foda MA, Bandoh K, et al. Posttraumatic ventriculomegaly: hydrocephalus or atrophy? A new approach for diagnosis using CSF dynamics[J]. J Neurosurg, 1996, 85(6): 1026-1035.
[33]
周良辅.负压和低压性脑积水[J].中华神经创伤外科电子杂志, 2016, 2(6): 321-327.
[34]
Carvi YNMN, Hollerhage HG. Early combined cranioplasty and programmable shunt in patients with skull bone defects and CSF-circulation disorders[J]. Neurol Res, 2006, 28(2): 139-144.
[35]
Aarabi B, Chesler D, Maulucci C, et al. Dynamics of subdural hygroma following decompressive craniectomy: a comparative study[J]. Neurosurg Focus, 2009, 26(6): E8.
[36]
Miranda P, Lobato RD, Rivas JJ, et al. Postraumatic subdural collections: case report and review of the literature[J]. Neurocirugia (Astur), 2004, 15(1): 67-71.
[37]
Lee KS. The pathogenesis and clinical significance of traumatic subdural hygroma[J]. Brain Inj, 1998, 12(7): 595-603.
[38]
Stone JL, Lang RG, Sugar O, et al. Traumatic subdural hygroma[J]. Neurosurgery, 1981, 8(5): 542-550.
[39]
Paredes I, Cicuendez M, Delgado MA, et al. Normal pressure subdural hygroma with mass effect as a complication of decompressive craniectomy[J]. Surgical neurology international, 2011, 2: 88-88.
[40]
Yang XJ, Hong GL, Su SB, et al. Complications induced by decompressive craniectomies after traumatic brain injury[J]. Chin J Traumatol, 2003, 6(2): 99-103.
[41]
Su FW, Ho JT, Wang HC. Acute contralateral subdural hygroma following craniectomy[J]. Journal of Clinical Neuroscience, 2008, 15(3): 305-307.
[42]
St John JN, Dila C. Traumatic subdural hygroma in adults[J]. Neurosurgery, 1981, 9(6): 621-626.
[43]
Kilincer C, Simsek O, Hamamcioglu MK, et al. Contralateral subdural effusion after aneurysm surgery and decompressive craniectomy: case report and review of the literature[J]. Clin Neurol Neurosurg, 2005, 107(5): 412-416.
[44]
Wang HK, Lu K, Liang CL, et al. Contralateral subdural effusion related to decompressive craniectomy performed in patients with severe traumatic brain injury[J]. Injury, 2012, 43(5): 594-597.
[45]
Yang XF, Wen L, Li G, et al. Contralateral Subdural Effusion Secondary to Decompressive Craniectomy Performed in Patients with Severe Traumatic Brain Injury: Incidence, Clinical Presentations, Treatment and Outcome[J]. Med Princ Pract, 2009, 18(1): 16-20.
[46]
杨小锋.正确认识和处理创伤性硬脑膜下积液[J].中华创伤杂志, 2016, 32(2): 102-104.
[47]
Wan Y, Shi L, Wang Z, et al. Effective treatment via early cranioplasty for intractable contralateral subdural effusion after standard decompressive craniectomy in patients with severe traumatic brain injury[J]. Clin Neurol Neurosurg, 2016, 149: 87-93.
[48]
Nasi D, Dobran M, Iacoangeli M, et al. Paradoxical Brain Herniation After Decompressive Craniectomy Provoked by Drainage of Subdural Hygroma[J]. World Neurosurg, 2016, 91: 673, e671-674.
[49]
Stiver SI, Wintermark M, Manley GT. Reversible monoparesis following decompressive hemicraniectomy for traumatic brain injury[J]. J Neurosurg, 2008, 109(2): 245-254.
[50]
Greitz D. Cerebrospinal fluid circulation and associated intracranial dynamics. A radiologic investigation using MR imaging and radionuclide cisternography[J]. Acta Radiol Suppl, 1993, 386: 1-23.
[51]
Wagshul ME, Eide PK, Madsen JR. The pulsating brain: A review of experimental and clinical studies of intracranial pulsatility[J]. Fluids Barriers CNS, 2011, 8(1): 5.
[52]
Idris Z, Mustapha M, Abdullah JM. Microgravity environment and compensatory: Decompensatory phases for intracranial hypertension form new perspectives to explain mechanism underlying communicating hydrocephalus and its related disorders[J]. Asian J Neurosurg, 2014, 9(1): 7-13.
[53]
Sarov M, Guichard JP, Chibarro S, et al. Sinking skin flap syndrome and paradoxical herniation after hemicraniectomy for malignant hemispheric infarction[J]. Stroke, 2010, 41(3): 560-562.
[54]
Attia M, Harel R, Harnof S, et al. Paradoxical transtentorial herniation in a patient with pseudotumor cerebri[J]. Isr Med Assoc J, 2006, 8(5): 355-356.
[55]
Tanrikulu L, Oez-Tanrikulu A, Weiss C, et al. The bigger, the better? About the size of decompressive hemicraniectomies[J]. Clin Neurol Neurosurg, 2015, 135: 15-21.
[56]
Fotakopoulos G, Tsianaka E, Siasios G, et al. Posttraumatic Hydrocephalus after Decompressive Craniectomy in 126 Patients with Severe Traumatic Brain Injury[J]. J Neurol Surg A Cent Eur Neurosurg, 2016, 77(2): 88-92.
[57]
Kan P, Amini A, Hansen K, et al. Outcomes after decompressive craniectomy for severe traumatic brain injury in children[J]. J Neurosurg, 2006, 105(5 Suppl): 337-342.
[58]
Jiang JY, Xu W, Li WP, et al. Efficacy of standard trauma craniectomy for refractory intracranial hypertension with severe traumatic brain injury: a multicenter, prospective, randomized controlled study[J]. J Neurotrauma, 2005, 22(6): 623-628.
[59]
Qiu W, Guo C, Shen H, et al. Effects of unilateral decompressive craniectomy on patients with unilateral acute post-traumatic brain swelling after severe traumatic brain injury[J]. Crit Care, 2009, 13(6): R185.
[60]
Songara A, Gupta R, Jain N, et al. Early Cranioplasty in Patients With Posttraumatic Decompressive Craniectomy and Its Correlation with Changes in Cerebral Perfusion Parameters and Neurocognitive Outcome[J]. World Neurosurg, 2016, 94: 303-308.
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