Microsurgery in the treatment of complex cerebral contusion and laceration

doi:10.3877/cma.j.issn.2095-9141.2021.01.005

Abstract

Abstract:

Objective

To analyze and summarize the experience and curative effect of microsurgery in the treatment of complex cerebral contusion and laceration.

Methods

The clinical data of 45 patients with complex cerebral contusion and laceration who underwent microsurgery in Neurosurgery Department of 900^th Hospital of Joint Service Support Force from January 2018 to December 2020 were retrospectively analyzed.

Results

Unilateral craniotomy for unilateral contusion and laceration in 27 cases, bilateral craniotomy for bilateral contusion and laceration in 11 cases, unilateral craniotomy for bilateral frontal lobe contusion and laceration in 4 cases, and 3 cases with bilateral contusion were treated with unilateral evacuation of hematoma. The hematoma was completely removed in 18 cases, a small amount remained in 17 cases, and a partial residual in 10 cases. Postoperative hematoma recurred in 1 case and died in 1 case. After 3-6 months of follow-up, it is found that 26 cases recovered well with good GOS score, 8 cases had moderate disability, 6 cases had severe disability and 4 cases with vegetative state.

Conclusion

Microsurgery helps surgeon to completely remove the hematoma, adequately decompress intracranial pressure, reduce unnecessary iatrogenic injury, and reduce the risk of postoperative complications.

Key words: Complex cerebral contusion and laceration, Severe traumatic brain injury, Microsurgery

Yinxing Huang, Zheng Liu, Qizuan Chen, Shangming Zhang, Jun Tian, Liang Xue, Shousen Wang. Microsurgery in the treatment of complex cerebral contusion and laceration[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2021, 07(01): 21-24.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsjcswkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9141.2021.01.005

https://zhsjcswkdzzz.cma-cmc.com.cn/EN/Y2021/V07/I01/21

Figures/Tables 1

References 14

[1]	Hilmer LV, Park KB, Vycheth I, et al. Cerebral contusion: an investigation of etiology, risk factors, related diagnoses, and the surgical management at a major government hospital in Cambodia[J]. Asian J Neurosurg, 2018, 13(1): 23-30.
[2]	Whitaker-Lea WA, Valadka AB. Acute management of moderate-severe traumatic brain injury[J]. Phys Med Rehabil Clin N Am, 2017, 28(2): 227-243.
[3]	吴喜，李智强，额布,等.改良大骨瓣减压术在部分额颞脑挫裂伤中的应用(附112例报告)[J].中华神经外科杂志, 2018, 34(12): 1266-1267.
[4]	刘窗溪，林浩，蒲天佑,等.显微神经外科手术中微创理念的践行[J].中华神经创伤外科电子杂志, 2020, 6(4): 248-250.
[5]	Cohen-Gadol AA. The art of microneurosurgery and passion for technical excellence[J]. J Neurosurg, 2018, 130(3): 1023-1027.
[6]	Khellaf A, Khan DZ, Helmy A. Recent advances in traumatic brain injury[J]. J Neurol, 2019, 266(11): 2878-2889.
[7]	Stocchetti N, Carbonara M, Citerio G, et al. Severe traumatic brain injury: targeted management in the intensive care unit[J]. Lancet Neurol, 2017, 16(6): 452-464.
[8]	Carney N, Totten AM, O’Reilly C, et al. Guidelines for the management of severe traumatic brain injury, fourth edition[J]. Neurosurgery, 2017, 80(1): 6-15.
[9]	Salehi A, Zhang JH, Obenaus A. Response of the cerebral vasculature following traumatic brain injury[J]. J Cereb Blood Flow Metab, 2017, 37(7): 2320-2339.
[10]	谭博，闫瑞妹，刘绍明.显微手术配合去骨瓣减压治疗额及颞叶脑挫裂伤的疗效[J].中华神经外科疾病研究杂志, 2016, 15(3): 261-262.
[11]	Savardekar AR, Patra DP, Narayan V, et al. Incidence, pathophysiology, and prevention strategies for cerebral venous complications after neurologic surgery: a systematic review of the literature[J]. World Neurosurg, 2018, 119: 294-299.
[12]	张尚明，刘海兵，王守森.经单侧入路双侧额叶脑挫裂伤清除术[J].中华神经创伤外科电子杂志, 2018, 4(2): 125-127.
[13]	刘海兵，魏梁锋，王守森,等.双侧额叶脑挫裂伤经单侧开颅显微镜下手术体会[J].中国微侵袭神经外科杂志, 2016, 21(7): 315-316.
[14]	陈雄辉，张鹏杰，徐峰,等.颅脑创伤术中出现急性脑膨出的原因分析及救治措施[J].创伤外科杂志, 2018, 20(10): 760-762.

[1]	Xiaozong Liang, Jiyong Jiang, Mandan Li, Haibin Lin, Changyi Wang. Free anteriolateral thigh perforator flap with fascia lata in repair of defects of foot and ankle [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(05): 672-675.
[2]	Qiang Wang, Guangzhe Jin, Jihui Ju, Kai Wang, Xiaoqiang Tang, Wentao Lv, Heyun Cheng, Lin Yang, Hailong Wang. Clinical application of the free medial arm flap to repair the finger wound with ultrasound-assisted positioning [J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(05): 393-397.
[3]	Rong Zhou, Jihui Ju, Yucheng Liu, Liang Yang, Liping Guo, Zhijin Liu, Guiyang Wang, Lin Yang, Junnan Cheng, Yongtao Huang, Chengwei Ge, Qianheng Jin, Yang Cao, Shi Wang, Shuai Dong. Classification and effective analysis of various blood supply reconstruction methods for using the bilateral anterolateral thigh flaps to repair the wound of whole foot degloving injury [J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(04): 299-306.
[4]	Jianke Liu, Linxi Xia, Xuchuan Zhou, Gejia Ma, Wenfei Wang, Aoshuang Qin, Xuefeng Su, Bin Liu. Effect of methylene blue lymphangiography combined with indocyanine green angiography in lymphaticovenular anastomosis [J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(03): 208-214.
[5]	Wang Zhou, Weihua Lü, Liwei Peng. Research progress on vascular crisis of vascularized free flap in oral and maxillofacial regions [J]. Chinese Journal of Stomatological Research(Electronic Edition), 2024, 18(03): 206-210.
[6]	Xiaoyuan Qiu, Guole Lin, Beizhan Niu, Junyang Lu, Guannan Zhang, Huizhong Qiu. Personalized application of TEM in mid-low rectal cancer [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(04): 210-217.
[7]	Deling Wei, Jiajun Jiang, Banghao Xu, Jilong Wang, Hai Zhu, Tingting Lu, Ling Zhang, Jingjing Zeng, Ya Guo, Zhang Wen. Application of microsurgical hepatic artery reconstruction in surgical treatment of cholangiocarcinoma involving the first porta hepatis [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(03): 350-356.
[8]	Changchun Cong, Chunlin Wang, Xiaogang Wu, Jinbiao Wang, Fubin Zhang, Lei Sun, Li Wang. Risk factors and etiology of ventilator-associated pneumonia in patients with severe traumatic brain injury [J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2024, 10(03): 151-157.
[9]	Tong Zhou, Jian Zhan, Juexian Xiao, Shaohui Gong, Zujue Cheng. Application of cavitron ultrasonic surgical aspirator in microsurgery of spinal lipoma surgery [J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2024, 10(02): 102-106.
[10]	Ruhai Wang, Chao Han, Qiang Yu, Haicheng Hu, Feilin Sun, Zhen Yang. Risk factors and predictive value of postoperative prolonged disorders of consciousness in patients with severe traumatic brain injury [J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2024, 10(02): 78-83.
[11]	Ruhai Wang, Shen Wang, Min Zhang, Chun Li, Chao Han, Qiang Yu, Haicheng Hu, Xizhen Li. Analysis of influencing factors of short-term mortality risk in patients with severe traumatic brain injury after decompressive craniectomy [J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2024, 14(05): 285-291.
[12]	Shen Wang, Ruhai Wang, Chun Li, Zhen Yang, Feilin Sun. Risk factors analysis and prediction model construction of prolonged length of stay in patients with moderate and severe traumatic brain injury [J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2024, 14(03): 146-153.
[13]	Xichao Dong, Linlin Wang, Zhihai Yuan, Wenwen Gao. Therapeutic effects of ultra-early microsurgery through the cerebral sulcus fissure vs the cerebral gyrus cortex approach for the treatment of basal ganglia hemorrhage [J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2024, 14(02): 100-105.
[14]	Lihua Chen. Principles and basis for selecting treatment methods for small and medium-sized vestibular schwannoma [J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2024, 14(01): 1-7.
[15]	Xiaojing Wang, Jiahan Lin, Jufeng Zhou, Chencui Li. Application of nutritional support at different timings in improving nutritional status and immune function in patients with severe traumatic brain injury [J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2023, 13(06): 335-339.

Please choose a citation manager

Content to export