Clinical study on the treatment of severe traumatic brain injury with cisternostomy and controlled drainage

doi:10.3877/cma.j.issn.2095-9141.2018.06.002

Abstract

Abstract:

Objective

To discuss the clinical application of cisternostomy and controlled drainage that cerebrospinal fluid in prepontine cistern in patients with severe traumatic brain injury (sTBI).

Methods

A total of 60 patients with sTBI in our department who needed surgical treatment were randomly divided into the standard decompression group (20 cases), the cisternostomy group (20 cases), the cisternostomy with drainage group (20 cases). The ventricular intracranial pressure (ICP) monitoring probe was indwelling before craniotomy, and recorded the main postoperative time points of ICP. GCS score was evaluated daily after the surgery. CT of the brain has been countercheck. Make a score with the Rotterdam CT scale and compare it with preoperative.

Results

The mean ICP values at different time points in the standard decompression group, the cisternostomy group and the cisternostomy with drainage group were compared, the differences were statistically significant (P<0.05). The GCS scores of cisternostomy plus drainage group were slightly higher than those of the other two groups at the main time points after operation. The improvement of postoperative CT score in the group of cisternostomy with drainage was statistically significant compared with the other two groups (P<0.05).

Conclusion

Controlled drainage of cerebrospinal fluid in the prepontine cistern can restore the circulation pathway of cerebrospinal fluid, which is helpful to recover nerve function and has effect on improving prognosis.

Key words: Severe traumatic brain injury, Cisternostomy, Decompressed craniectomy, Drainage, Intracranial pressure

Hui Yang, Yonghong Wang, Zhenyang Liu, Haibo Tong. Clinical study on the treatment of severe traumatic brain injury with cisternostomy and controlled drainage[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2018, 04(06): 324-328.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsjcswkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9141.2018.06.002

https://zhsjcswkdzzz.cma-cmc.com.cn/EN/Y2018/V04/I06/324

Figures/Tables 3

References 16

[1]	章翔，费舟，王占祥,等.重型颅脑损伤临床救治经验[J].中华神经外科疾病研究杂志, 2003, 2(3):203-207.
[2]	王忠诚.王忠诚神经外科学[M].武汉:湖北科学技术出版社, 2005: 59-63, 432-435.
[3]	Chi JH. Craniectomy for traumatic brain injury: results from the DECRA trial[J]. Neurosurgery, 2011, 68(6):N19-N20.
[4]	张建永，刘保华，陆海,等.标准大骨瓣减压术后颅腔容积代偿能力的探讨[J].中华神经外科杂志, 2008, 24(1):78.
[5]	韦英光，谭毅.重型颅脑损伤治疗的研究进展[J].中国临床新医学, 2013, 6(6):604-608.
[6]	Cherian I, Grasso G, Bernardo A, et al. Anatomy and physiology of cisternostomy[J]. Chin J Traumatol, 2016, 19(1):7-10.
[7]	王永红，郭敏，梁磊,等.脑池造瘘术在重型颅脑损伤中的临床应用[J].中华神经创伤外科电子杂志, 2018, 4(2):119-121.
[8]	Iliff JJ, Wang M, Liao Y, et al. A paravascular pathway facilitates csf flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid β[J]. Sci Transl Med, 2012, 4(147):147ra111.
[9]	Shulman K. Small artery and vein pressures in the subarachnoid space of the dog[J]. J Surg Res, 1965, 5(2):56-61.
[10]	林超，董艳，于明琨,等.创伤性颅脑损伤去骨瓣减压术后并发症的危险因素分析[J].第二军医大学学报, 2012, 33(11):1260-1262.
[11]	Cherian I, Beltran M, Landi A, et al. Introducing the concept of "CSF-shift edema" in traumatic brain injury[J]. J Neurosci Res, 2018, 96(4):744-752.
[12]	亚萨吉尔MG.脑池和脑血管的显微外科解剖,诊断研究,手术技巧总论,颅内动脉瘤的病理学.显微神经外科学[M].凌锋,译.北京:中国科学技术出版社, 2002: 6-16.
[13]	王双豹，冯国强，赵伟然,等.术中打开Liliequist膜对动脉瘤性蛛网膜下腔出血所致慢性脑积水的预防研究[J].西北国防医学杂志, 2015, 36(3):186-187.
[14]	江基尧，李维平，徐蔚,等.标准外伤大骨瓣与常规骨瓣治疗重型颅脑损伤多中心前瞻性临床对照研究[J].中华神经外科杂志, 2004, 20(1):37-40.
[15]	Huang YH, Deng YH, Lee TC, et al. Rotterdam computed tomography score as a prognosticator in head-injured patients undergoing decompressive craniectomy[J]. Neurosurgery, 2012, 71(1):80-85.
[16]	Maas AI, Hukkelhoven CW, Marshall LF, et al. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors[J]. Neurosurgery, 2005, 57(6):1173-1182.

组别	例数	2h	6 h	12 h	1 d	3d	5d
去骨瓣组	20	13.52±8.49	15.37±6.95	16.39±6.80	19.35±4.90	19.68±4.52	16.08±3.33
脑池造瘘组	20	8.89±2.56^a	10.74±3.25^a	11.17±3.09^a	13.97±2.40^a	14.27±2.87^a	13.97±1.93^a
脑池造瘘+引流组	20	6.00±2.14^ab	7.16±1.83^ab	8.10±1.89^ab	11.17±3.89^ab	10.39±1.54^ab	10.57±2.05^ab
F值	?	10.386	16.349	17.770	23.091	42.175	24.394
P值	?	0.001	0.001	0.001	0.001	0.001	0.001

组别	例数	2h	6 h	12 h	1 d	3d	5d
去骨瓣组	20	13.52±8.49	15.37±6.95	16.39±6.80	19.35±4.90	19.68±4.52	16.08±3.33
脑池造瘘组	20	8.89±2.56^a	10.74±3.25^a	11.17±3.09^a	13.97±2.40^a	14.27±2.87^a	13.97±1.93^a
脑池造瘘+引流组	20	6.00±2.14^ab	7.16±1.83^ab	8.10±1.89^ab	11.17±3.89^ab	10.39±1.54^ab	10.57±2.05^ab
F值	?	10.386	16.349	17.770	23.091	42.175	24.394
P值	?	0.001	0.001	0.001	0.001	0.001	0.001

组别	例数	术前	术后
组别	例数	术前	1d	3d	5d	7d	15 d
去骨瓣组	20	6.16±1.12	6.32±1.29	6.68±1.77	7.05±2.22	8.37±2.75	10.53±2.34
脑池造瘘组	20	6.15±1.27	6.75±1.12	7.15±1.46	7.85±1.57	8.55±1.70	10.85±2.03
脑池造瘘+引流组	20	6.15±1.18	6.85±1.79	7.80±1.88	8.40±1.73	9.75±1.86	12.00±2.29

组别	例数	术前	术后
组别	例数	术前	1d	3d	5d	7d	15 d
去骨瓣组	20	6.16±1.12	6.32±1.29	6.68±1.77	7.05±2.22	8.37±2.75	10.53±2.34
脑池造瘘组	20	6.15±1.27	6.75±1.12	7.15±1.46	7.85±1.57	8.55±1.70	10.85±2.03
脑池造瘘+引流组	20	6.15±1.18	6.85±1.79	7.80±1.88	8.40±1.73	9.75±1.86	12.00±2.29

组别	例数	术前			术后
组别	例数	3分	4分	5分	1分	2分	3分	4分	5分
去骨瓣组	20	3（15.0）	10（50.0）	7（35.0）	1（5.0）	8（40.0）	7（35.0）	3（15.0）	1（5.0）
脑池造瘘组	20	5（25.0）	7（35.0）	8（40.0）	4（20.0）	10（50.0）	3（15.0）	3（15.0）	0（0.0）
脑池造瘘+引流组	20	3（15.0）	10（50.0）	7（35.0）	7（35.0）^a	9（45.0）^a	4（20.0）^a	0（0.0）^a	0（0.0）^a
χ²值	?	?	1.485	?	?	?	8.598	?	?
P值	?	?	0.829	?	?	?	0.014	?	?

Please choose a citation manager

Content to export