探讨创伤性脑积水（PTH）合并颅骨缺损患者优先行颅骨修补而后行脑积水分流术的可行性，以及其对降低患者术后并发症、改善预后的临床意义。

选取济宁医学院附属医院邹城院区神经外科自2012年1月至2017年10月收治的32例PTH合并颅骨缺损患者为研究对象，均先以三维塑形钛网进行颅骨修补术，其中存在骨窗区明显脑膨出的患者，颅骨修补术中采取直接脑室穿刺释放脑脊液的方法促使膨出脑组织复位以利于钛网覆盖固定。颅骨修补术后1~3周根据脑积水临床症状变化将符合分流指征的患者择期再行脑脊液分流术。观察患者术后总体并发症发生情况及术后6个月GOS预后情况。

32例患者优先行颅骨修补术全部得以顺利实施，颅骨修补术后无明显相关并发症发生，其中28例再次接受脑积水分流术，4例因颅骨修补术后脑积水症状持续缓解未再接受分流术。术后脑积水症状较术前明显改善，有效率为94%；分期手术总并发症发生率为6.25%。术后6个月随访，本组患者中预后良好24例，中残4例，重残3例，死亡1例。

对于所有PTH合并颅骨缺损的患者，优先进行颅骨修补而后根据病情择期再行脑积水分流术的分期手术方案是切实可行的，且术后并发症发生率更低，对改善患者预后有重要临床意义。

To explore the post-traumatic hydrocephalus (PTH) combined with skull defect patients undergoing cranioplasty and hydrocephalus shunting, and its clinical significance in reducing postoperative complications and improving prognosis.

Thirty-two patients with PTH and skull defect treated in Zoucheng Hospital, Affiliated Hospital of Jining Medical College from January 2012 to October 2017 were selected as the study subjects, and all patients underwent cranioplasty with three-dimensional plastic titanium mesh. There were patients with obvious encephalocele in the bone window area. During cranioplasty, direct ventricular puncture was used to release cerebrospinal fluid to promote the reduction of the encephalocele tissue in order to facilitate the coverage and fixation of titanium mesh. According to the changes of clinical symptoms of hydrocephalus, patients who meet the shunt indications will be selected for CSF shunt 1-3 weeks after cranioplasty. Observe the overall complications and good prognosis of GOS 6 months after operation.

All 32 patients were treated with cranioplasty successfully without obvious complications. Twenty-eight cases were treated with hydrocephalus shunt operation. The symptoms of hydrocephalus in 4 cases reduced gradually after cranioplasty, and these patients received no shunt operation. The improvement rate of hydrocephalus symptoms was 94% compared with preoperative, and the total complication rate was 6.25%. After 6 months follow-up, the good prognosis was achieved in 24 cases, moderate disability in 4 cases, severe disability in 3 cases, and death in 1 case.

For all patients with PTH complicated with skull defect, it is a feasible operative method to repair the skull first and then reperform hydrocephalus shunt according to the patient’s condition. The overall complication rate of operation is lower than that of the patients with PTH. It is of great clinical significance to improve the prognosis of the patients.