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Objective To investigate the clinical effects and complications of different period cranioplasty after decompressive craniectomy in patients with craniocerebral injury.Methods The clinical data of 96 craniocerebral injury patients who had underwent decompressive craniectomy in the First Affiliated Hospital of Chengdu Medical College from January 2014 to January 2018 were retrospectively analyzed.According to the different time of cranioplasty,the patients were divided into early group and routine group.In the early group,50 patients received cranioplasty between 1.5 to 3.0 months after decompressive craniectomy;while in the conventional group,46 patients received cranioplasty between 3.1 to 6.0 months after decompressive craniectomy.The complications after cranioplasty were observed in 2 groups,and Glasgow outcome score (GOS) and Karnofsky performance score (KPS) before cranioplasty and 3,6 and 12 months after cranioplasty were recorded.Results There were no statistical difference in delayed wound healing,subcutaneous hydrops,incision infection,hydrocephalus,intracranial hemorrhage and total incidence of complications between 2 groups (P ＞ 0.05).However,the incidence of postoperative epilepsy in early group was significantly lower than that in routine group:0 vs.8.70％ (4/46),and there was statistical difference (P ＜ 0.05).There were no statistical differences in GOS and KPS before cranioplasty between 2 groups (P ＞ 0.05);the GOS and KPS 3,6 and 12 months after cranioplasty in early group were significantly higher than those in routine group,GOS:(3.58 ± 0.64) scores vs.(3.20 ± 0.74) scores,(3.90 ± 0.58) scores vs.(3.61 ± 0.61) scores and (4.22 ± 0.55) scores vs.(3.98 ± 0.45) scores;KPS:(56.20 ± 8.55) scores vs.(52.17 ± 7.86) scores,(68.40 ± 9.12) scores vs.(63.91 ± 10.22) scores and (75.20 ± 9.31) scores vs.(70.43 ± 10.53) scores,and there were statistical differences (P＜0.01 or ＜0.05).Conclusions Early cranioplasty after decompressive craniectomy in patients with craniocerebral injury can not only reduce the incidence of postoperative epilepsy,but also be more conducive to the recovery of postoperative neurological function and improve the prognosis of patients.
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Objective@#To investigate the clinical effects and complications of different period cranioplasty after decompressive craniectomy in patients with craniocerebral injury.@*Methods@#The clinical data of 96 craniocerebral injury patients who had underwent decompressive craniectomy in the First Affiliated Hospital of Chengdu Medical College from January 2014 to January 2018 were retrospectively analyzed. According to the different time of cranioplasty, the patients were divided into early group and routine group. In the early group, 50 patients received cranioplasty between 1.5 to 3.0 months after decompressive craniectomy; while in the conventional group, 46 patients received cranioplasty between 3.1 to 6.0 months after decompressive craniectomy. The complications after cranioplasty were observed in 2 groups, and Glasgow outcome score (GOS) and Karnofsky performance score (KPS) before cranioplasty and 3, 6 and 12 months after cranioplasty were recorded.@*Results@#There were no statistical difference in delayed wound healing, subcutaneous hydrops, incision infection, hydrocephalus, intracranial hemorrhage and total incidence of complications between 2 groups (P>0.05). However, the incidence of postoperative epilepsy in early group was significantly lower than that in routine group: 0 vs. 8.70% (4/46), and there was statistical difference (P<0.05). There were no statistical differences in GOS and KPS before cranioplasty between 2 groups (P>0.05); the GOS and KPS 3, 6 and 12 months after cranioplasty in early group were significantly higher than those in routine group, GOS: (3.58 ± 0.64) scores vs. (3.20 ± 0.74) scores, (3.90 ± 0.58) scores vs. (3.61 ± 0.61) scores and (4.22 ± 0.55) scores vs. (3.98 ± 0.45) scores; KPS: (56.20 ± 8.55) scores vs. (52.17 ± 7.86) scores, (68.40 ± 9.12) scores vs. (63.91 ± 10.22) scores and (75.20 ± 9.31) scores vs. (70.43 ± 10.53) scores, and there were statistical differences (P<0.01 or <0.05).@*Conclusions@#Early cranioplasty after decompressive craniectomy in patients with craniocerebral injury can not only reduce the incidence of postoperative epilepsy, but also be more conducive to the recovery of postoperative neurological function and improve the prognosis of patients.
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Delayed cerebral ischemia (DCI) is an important cause of neurological deterioration in patients with aneurysmal subarachnoid hemorrhage (aSAH). The occurrence and development of DCI after aSAH is not only associated with cerebral vasospasm, but also with the inflammatory reaction. This article reviews the role of inflammatory reaction in DCI and the predictive value of inflammatory markers for DCI.
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Objective To compare the clinical effects and safety of surgical clipping and intravascular interventional therapy in treatment of intracranial wide-necked aneurysm.Methods The clinical data of 158 patients with intracranial wide-necked aneurysm from February 2010 to February 2013 were retrospectively analyzed,all patients were divided into two groups:surgical clipping group with 92 cases and intravascular interventional therapy group with 66 cases,the postoperative curative effects,treatment time,hospital stay,hospital expenses and postoperative complications between two groups were compared.Followed up for 10-46 months,the recurrence rate were compared.Results The good prognosis and defective rates between surgical clipping group and intravasular interventional therapy group had no significant difference [90.2％(83/92) vs.90.9％(60/66),9.8％(9/92) vs.9.1％ (6/66)] (x2 =0.298,P ＞ 0.05).The preoperative Hunt-Hess classification and CT Fisher classification between two groups had no significant difference (P ＞ 0.05).Six months after discharge,mRS score was used to evaluate the curative effect,the defective rates in same level patients between two kinds of treatment methods had no significantdifference (P ＞ 0.05).The treatment time,hospital stay in surgical clipping group were significantly longer than those in intravascular interventional therapy group [(4.03 ± 1.01) h vs.(1.61 ± 0.98) h,(15.90 ± 2.03) dvs.(13.20 ± 1.95) d],hospital expenses was significantly lower than that in intravascular intervention therapy group [61 829.4 ±320.6) yuan vs.(99 876.2 ±371.5) yuan] (P ＜0.05).The postoperative complications rate between two groups had no significant difference (P ＞ 0.05).Followed up for 31.3 (10-46) months,the recurrence rate in surgical clipping group was significantly lower than that in intravascular intervention therapy group [1.1％ (1/94) vs.8.8％ (6/68)] (P ＜ 0.05).Conclusion Surgical clipping and intravascular interventional therapy in treatment of intracranial wide-necked aneurysm has their own different characteristics,so patients' treatment methods should be based on their preoperative status (especially preoperative Hunt-Hess and Fisher classification) and patients' economic conditions.
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Objective To discuss the clinical effects of using CT positioning keyhole approach to treat hy-pertensive intracerebral hemorrhage (HICH).Methods 85 cases of patients with hypertensive intracerebral hemor-rhage(HICH) were chosen and divided into two groups according to the operation methods:the observation group had 55 cases given CT positioning keyhole approach ,while the control group had 30 cases treated with traditional cranioto-my hematoma removal operation .All patients were supplemented by postoperative blood pressure control and nutrition -al support treatment .The average operation time ,hematoma disappearing time ,the length of hospital stay and re-bleed-ing rates and postoperative ability of daily life ( ADL) scores of the two groups were all carefully recorded and com-pared.Results The average operation time,hematoma disappearing time and hospital stay of the observation group were (66.5 ±12.8)min,(3.4 ±1.3)d,and (9.3 ±1.7)day which were all significantly lower than those of the con-trol group(193.5 ±23.7)min,(5.8 ±2.1)d and (15.2 ±3.8)d;T-test values of the two groups were 2.874,3.125 and 3.433 separately(P0.05).6 months′follow-up after opera-tion,in the control group 2 cases were lost to follow-up while in the observation group 3 cases were lost to follow-up;Using ADL to evaluate the two groups of patients with survival and continuous follow-up,we found that the observation group′s postoperative quality of life was better than that of the control group′s(μ=3.325,P<0.05).Conclusion Using CT positioning keyhole approach has smaller trauma , shorter operation time and faster postoperative recovery and other characteristics,which is an effective method for the treatment of hypertensive intracerebral hemorrhage(HICH).