总结创伤性颅脑损伤（TBI）后大骨瓣减压术后脑积水发生的危险因素与治疗措施。

单中心回顾性队列研究济南军区总医院神经外科自2012年7月至2016年12月收治的TBI后行大骨瓣减压术的196例幸存患者的临床资料，根据患者术后5~15 d内的头颅CT或MRI影像资料分为2组：有纵裂积液或/和硬膜下积液为A组（n=81），无纵裂积液或/和硬膜下积液为B组（n=115）。2组病例复查出现纵裂积液或/和硬膜下积液者给予腰大池持续外引流术及脑室-腹腔分流术（VPS）。

随访6个月复查头颅CT或MRI，A组81例患者中57例出现脑积水，发生率70.0%，B组115例患者中仅10例出现脑积水，发生率8.7%。2组患者脑积水发生率差异有统计学意义（χ²=80.35，P<0.05）。A组患者给予5~10 d腰大池持续外引流术，术后未出现脑积水症状的患者24例，有效率42.1%；B组6个月内随访并发脑积水者10例，给予腰大池持续引流4~7 d，拔出引流术管后脑积水复发10例。2组经治疗后共67例脑积水患者行VPS，脑积水影像学表现及患者临床症状（GCS评分增高）改善者62例，有效率92.5%。

TBI后行大骨瓣减压术出现纵裂积液或/和硬膜下积液是脑积水发生的因素之一。一旦出现纵裂积液或/和硬膜下积液，则应对患者追踪头颅CT随访，给予积极对症治疗改善临床症状。

To summarize the risk factors and treatment of hydrocephalus after traumatic craniocerebral trauma.

A single center retrospective cohort study of 196 surviving patients with traumatic craniocerebral trauma after traumatic craniocerebral trauma from July 2012 to December 2016 in Department of Neurosurgery, Ji’nan Military General Hospital, was divided into 2 groups according to the skull CT or MRI images within 5-15 d after operation: longitudinal fissure effusion or/and subdural subdural. The effusion was A group (81 cases), and no longitudinal fissure effusion or/or subdural effusion was B group (115 cases). Continuous lumbar external cistern drainage and ventriculoperitoneal shunt were used to treat patients with longitudinal fissure effusion and/or subdural effusion in group A.

CT or MRI were followed up for 6 months. Fifty seven of the 81 patients in group A had hydrocephalus, the incidence was 70%. Only 10 of the 115 patients in group B had hydrocephalus, and the incidence was 8.7%. The incidence of hydrocephalus in the 2 groups was statistically significant (χ²=80.35, P<0.05). Patients in group A were given 5-10 d lumbar cistern continuous external drainage, 24 patients had no symptoms of hydrocephalus after operation, and the effective rate was 49%. Group B was followed up with hydrocephalus in 10 cases within 6 months, and 4-7 d was continuously drained in the lumbar cistern, and 10 cases of hydrocephalus were relapsed after pulling out the drainage tube. Two groups of A and B were treated with ventriculoperitoneal shunt (VPS), hydrocephalus imaging and patients’clinical symptoms (GCS score increased) in 62 cases, with an effective rate of 92.5%.

The occurrence of longitudinal hydrops and/or subdural effusion after craniocerebral trauma is one of the causes of hydrocephalus. Once there is longitudinal fissure effusion and/or subdural effusion, follow up CT follow-up should be followed, positive symptomatic treatment should be given and clinical symptoms should be improved.