ABSTRACT
Objective To analyze and summarize the experiences in diagnosis and treatment of patients with severe traumatic brain injury (sTBI) so as to increase the cure rate and survival rate. Methods A retrospective study was made on the diagnoses and treatment of 4 462 cases of sTBI inclu-ding 3 298 males (73.9%) and 1 164 females (26.1%). The most frequent cause for injury was traffic accident, accounting for 35.5% (1 583/4 462). Closed bead injury ocurred in 3 654 cases (81.9%) and open head injury in 808 (18.1%). The most commen clinical manifestations included unconscious-ness, changes of pupils and life signs. Of all, 1 158 cases (26.0%) were found with combined injury and 1 356 (30.4%) with complications. Treatment measures included first aid, surgery or conventional treatment. Emphasis was put on the treatment of secondary insults. Results Surgery was performed in 3 023 cases (67.7%) including craniotomy for hematoma clearance in 856 cases and hematoma clearance plus decompression in 2 167, with mortality rate of 17.9%. Conventional treatment was carried out in 1 439 cases (32.3%), with mortality rate of 23.7%. There were 2 462 eases (55.2%) with fair recov-ery, 508 (11.4%) with mild disability, 339 (7.6%) with severe disability, 272 (6.1%) under vege-tative state and 881 (19.7%) deaths on discharge according to the Glasgow Outcome Scale. Conelu-sions Active diagnoses and treatment, strict medication rules and prevention and treatment of secondary insults may be key to higher eure rate as well as lower morbidity and mortality of sTBI.
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Objective To sum up the experiences in microneurosurgical treatment of spinal cord cavernous hemangiomas (SCH). Methods A retrospective analysis was made of 17 cases of SCH admitted from March 1992 to December 2002. Operations were performed via a posterior midline approach under a microscope. Results Total SCH resection was done in 13 cases, and subtotal removal in 4. The postoperative neurological status was improved in 11 cases, unchanged in 4, and aggravated in 2. No postoperative death occurred. Conclusion Spinal MRI examination is a reliable diagnostic method of SCH. Skillful microneurosurgical technique can achieve a rather good result.
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Objective To evaluate the diagnosis and microsurgical treatment of intraspinal abscesses. Methods The clinical manifestations, diagnosis, and microsurgical treatment of sixty-two patients with intraspinal abscess were retrospectively analyzed. Among them, 36 were male and 26 were female, with an average age of 41 years. Thirty-seven were suffering from extradural abscesses, 23 subdural abscesses and 2 intramedullary abscesses. The diagnosis was made based on the history, clinical manifestations, MRI and myelogram. Prompt decompressive laminectomy and removal of the abscesses were carried out. Results Fifty-one patients were followed up. Of them, 27 completely recovered, accounting for 52.9%; in 18 the recovery was graded as good, accounting for 35.3%; and in 6 the recovery was fair, accounting for 11.8%. Conclusion Early diagnosis and microsurgical intervention of intraspinal abscesses could result in satisfactory recovery.
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To improve the microsurgical curative effect of petroclival cholesteatoma (PCC), 52 patients harbouring PCC removed from 1993 to 2002 were analyzed retrospectively. Of all patients in this group, total tumor removal was achieved in 47 patients (90%), subtotal removal in 5 (10%). The new cranial nerve injuries occurred postoperatively in 4. Operative death occurred in 1 patient due to severe lung infection (1 9%). The key goal of surgical resection of the tumor was good. Suitable basicranial approaches and skillful microsurgical technique can increase the total removal rate, and decrease its mortality and morbidity.
ABSTRACT
OBJECTIVE: To improve the outcome of treatment in patients with craniocerebral firearm wound. METHODS: Prospectively and retrospectively reviewed a series of 93 patients presented to the Xi-Jing Hospital of Fourth Military Medical University with a diagnosis of craniocerebral firearm wound during a period of 27 years from July 1970 to July 1997. All the patients had acute craniocerebral firearm wound. Of these, it consisted of 81 males (87.1%) and 12 females (12.9%) ranging from 3 months to 58 years in age (median 24.6 years). The lesion included 16 tangential wounds, 58 tubular wounds and 19 through-and-through wounds. The cases were urgent and in serious and unstable condition. All the patients underwent surgical intervention and aggressive perioperative management in the neurosurgical intensive care, including resuscitative protocols. RESULTS: After emergency treatment and operation, 9 cases died (9.7%). Follow-up studies at three months postoperative showed that 56 cases (66.7%) had made good recovery. Rates of moderate disability, severe disability or vegetative state in this series were 19.0%, 10.7% and 3.6%, respectively. Long term follow-up studies (median 5.5 years) found that 42 (50.0%) were capable of resuming their occupation. CONCLUSIONS: Craniocerebral firearm wounds are often severe, needing urgent treatment for the patients. Timely, proper and thorough initial debridement are crucial for avoiding rapid neurological deterioration.