ABSTRACT
Objective To investigate the effects of three-dimensional titanium mesh repair on cerebral perfusion,intracranial pressure and nerve function after decompression with bone flap.Methods From October 2015 to October 2018,132 hypertensive cerebral hemorrhage patients of bone disc decompression in the Fifth People's Hospital of Jinan were selected and divided into observation group (66 cases) and control group(66 cases) by double blind random method.The observation group received three-dimensional titanium mesh repair at 24 ～ 42 d after bone disc decompression surgery.The control group received three-dimensional titanium mesh repair at 90 ～ 150 d(3 ～ 5 months) after surgery.The changes of operation,cerebral perfusion,intracranial pressure and nerve function were compared between the two groups.Results The operative time,blood loss and free time of the flap in the observation group were (92.5 ± 12.4) min,(354.3 ± 17.5) mL and (13.2 ± 3.1) min,respectively,which were shorter or less than those in the control group [(142.8 ± 15.3) min,(518.3 ± 22.3) mL and (38.3 ± 4.3) min],the differences between the two groups were statistically significant (t=4.745,6.831,4.963,all P ＜ 0.05).After treatment,the abnormal indices of intracranial pressure and cerebral perfusion in the observation group were (0.1 ±0.0) and(0.2 ± 0.1),respectively,which were lower than those in the control group [(0.2 ± 0.1),(0.3 ± 0.1)] (t =3.657,2.579,all P ＜0.05).There were statistically significant differences in neurological deficit scores between the two groups at different time points(all P ＜0.05).The incidence of treatment complications in the observation group was 10.94％ (7/64),which was significantly lower than that in the control group [38.7％ (24/62)] (x2 =14.094,P ＜ 0.05).Conclusion Three-dimensional titanium mesh repair is helpful to shorten the operation time,restore the intracranial pressure on the affected side,improve the abnormal cerebral perfusion,and reduce the neurological damage in patients with hypertensive cerebral hemorrhage.
ABSTRACT
BACKGROUND:Craniotomy for severe traumatic brain injury is required to maintain the integrity of the dura mater. The artificial dura mater is now a common dural repair material, and looking for the ideal artificial dura mater is the exploring direction of neurosurgery. OBJECTIVE:To explore the application of colagen sponge artificial dura in severe traumatic brain injury METHODS:A retrospective analysis of 96 patients with severe head injury was performed, including 32 cases of the artificial dura with tightly suturing as the control group, and 64 cases of the artificial dura of colagen sponge without suturing as the experimental group. Operating time for hematoma clearance, blood loss, postoperative mechanical ventilation time, ICU monitoring time, the total number of hospitalized days as wel as time interval from hematoma clearance to cranioplasty, operative time for cranioplasty, blood loss, and Glasgow Coma Scale scores after dural damage and 6 months postoperatively in the two groups were measured. RESULTS AND CONCLUSION:The same purpose was achieved in the two groups. The amount of bleeding during hematoma clearance, postoperative mechanical ventilation time, monitoring time in ICU, the total number of hospitalized days and Glasgow Coma Scale score of 6 months postoperatively showed no significant difference between the two groups (P> 0.05). But operative time for hematoma clearance and cranioplasty as wel as blood loss in the second operation were statisticaly significant between two groups (P< 0.05). The colagen sponge artificial dura in severe traumatic brain injury can fuly play a good role in reducing intracranial pressure, keeping brain functions, shortening operative time, and improving outcomes of patients, which has similar effects to tightly suturing the dura and creates favorable conditions for the folowing cranioplasty.