The effect of hematoma puncture drainage before decompressive craniectomy on the prognosis of hypertensive intracerebral hemorrhage with cerebral hernia at a high altitude / 中华创伤杂志(英文版)

PURPOSE@#Rapid decompressive craniectomy (DC) was the most effective method for the treatment of hypertensive intracerebral hemorrhage (HICH) with cerebral hernia, but the mortality and disability rate is still high. We suspected that hematoma puncture drainage (PD) + DC may improve the therapeutic effect and thus compared the combined surgery with DC alone.@*METHODS@#From December 2013 to July 2019, patients with HICH from Linzhi, Tibet and Honghe, Yunnan Province were retrospectively analyzed. The selection criteria were as follows: (1) altitude ≥1500 m; (2) HICH patients with cerebral hernia; (3) Glascow coma scale score of 4-8 and time from onset to admission ≤3 h; (4) good liver and kidney function; and (5) complete case data. The included patients were divided into DC group and PD + DC group. The patients were followed up for 6 months. The outcome was assessed by Glasgow outcome scale (GOS) score, Kaplan-Meier survival curve and correlation between time from admission to operation and prognosis. A good outcome was defined as independent (GOS score, 4-5) and poor outcome defined as dependent (GOS score, 3-1). All data analyses were performed using SPSS 19, and comparison between two groups was conducted using separate t-tests or Chi-square tests.@*RESULTS@#A total of 65 patients was included. The age ranged 34-90 years (mean, 63.00 ± 14.04 years). Among them, 31 patients had the operation of PD + DC, whereas 34 patients underwent DC. The two groups had no significant difference in the basic characteristics. After 6 months of follow-up, in the PD + DC group there were 8 death, 4 vegetative state, 4 severe disability (GOS score 1-3, poor outcome 51.6 %); 8 moderate disability, and 7 good recovery (GOS score 4-5, good outcome 48.4 %); while in the DC group the result was 15 death, 6 vegetative state, 5 severe disability (poor outcome 76.5 %), 4 moderate disability and 4 good recovery (good outcome 23.5 %). The GOS score and good outcome were significantly less in DC group than in PD + DC group (Z = -1.993, p = 0.046; χ@*CONCLUSION@#PD + DC treatment can improve the good outcomes better than DC treatment for HICH with cerebral hernia at a high altitude.

Primary Amebic Meningoencephalitis: A Case Report

Primary amebic encephalitis (PAM) is a devastating central nervous system infection caused by Naegleria fowleri, a free-living amoeba, which can survive in soil and warm fresh water. Here, a 43-year-old healthy male was exposed to warm freshwater 5 days before the symptom onset. He rapidly developed severe cerebral edema before the diagnosis of PAM and was treated with intravenous conventional amphotericin B while died of terminal cerebral hernia finally. Comparing the patients with PAM who has similar clinical symptoms to those with other common types of meningoencephalitis, this infection is probably curable if treated early and aggressively. PAM should be considered in the differential diagnosis of purulent meningoencephalitis, especially in patients with recent freshwater-related activities during the hot season.

Effects of improved emergency nursing intervention on complications and clinical prognosis in patients with severe craniocerebral injury accompanied by cerebral hernia / 中国中西医结合急救杂志

Objective To explore the effects of improved emergency nursing intervention on complications and clinical prognosis of severe patients with craniocerebral injury accompanied by cerebral hernia, and provide evidence for clinical nursing. Methods The patients with severe craniocerebral injury accompanied by cerebral hernia were enrolled in Dongguan People's Hospital from January 2016 to December 2018. According to the admission time, the patients were divided into routine nursing group (Admission from January 2016 to June 2017) and improved emergency nursing methods group (Admission from July 2017 to December 2018). To analyze the effect of two different nursing methods on the prognosis of patients by improving first aid nursing measures and routine nursing. Both groups of patients underwent craniotomy, the conventional nursing group was treated with routine operating room care, the improved emergency nursing methods group was given improved emergency care interventions based on the conventional nursing, the operation preparation time, operation time, intra-operative blood loss and the incidence of postoperative complications, clinical prognosis of the two groups were observed; the self-made questionnaire was used to evaluate the scores of the patient's satisfaction and compliance. Results The operation preparation time, operation time and intra-operative blood loss of the improved emergency nursing methods group (40 cases) were significantly lower than those in the conventional nursing group [40 cases, operation preparation time (minutes): 25.03±5.47 vs. 36.73±5.83, operation time (minutes): 52.56±10.63 vs. 92.10±10.73, intra-operative blood loss (mL): 218.73±20.74 vs. 402.66±23.70, all P < 0.05]; the clinical good prognosis rate, rate of satisfaction to nursing, treatment compliance score of the improved emergency nursing methods group were significantly higher than those of the conventional nursing group [clinical good prognosis rate: 20.0% (8/40) vs. 12.5% (5/40), rate of satisfaction to nursing: 95.0% (38/40) vs. 82.5% (33/40), treatment compliance scores: 95.83±4.09 vs. 81.27±5.04, all P < 0.05]; the complication rate of the improved emergency nursing methods group was significantly lower than that of the conventional nursing group [32.5% (13/40) vs. 55.0% (22/40), P <0.05]. Conclusion The improved emergency nursing intervention can significantly improve the clinical prognosis and reduce the incidence of complications in patients with severe craniocerebral injury accompanied by cerebral hernia, so that the clinical application value is relatively high.

Value of minimally invasive puncturation via hard tunnel in decompression before craniotomy for acute subdural hematoma combined with cerebral hernia / 中华创伤杂志

Objective To explore the value of minimally invasive puncturation via the hard tunnel in decompression before craniotomy for acute subdural hematoma combined with cerebral hernia.Methods A retrospective method was adopted to analyze the clinical data of 303 patients with traumatic acute subdural hematoma combined with cerebral hernia treated from January 2004 to October 2016.There were 206 males and 97 females,with age range of 12-77 years [(43.6 ± 20.1) years].The Glasgow coma scale (GCS) was 3-5 points in 187 patients and 6-8 points in 116.The patients were divided into study group (n =199) and control group (n =104) according to the different surgical procedures.For study group,the patients were treated with disposable ventricular needle to suck out and drain the intracranial hematoma,and the skull was opened through the large craniotomy to remove the subdural hematoma.For control group,the skull was opened through the large craniotomy which was used to directly remove the subdural hematoma according to the traditional instruction.The differences between two groups were compared with regard to time from confirming the cerebral hernia to the first decompression,time of regaining consciousness after surgery,hospitalization duration and cranial cavity infection after surgery.Glasgow outcome scale (GOS) was used to evaluate the prognosis.Results The time to first decompression was 10-15 minutes [(12.5 ± 1.7)minutes] in study group and 50-75 minutes [(133.0 ± 7.9) minutes] in control group (P ＜ 0.05).Regaining consciousness within 3 days after surgery was found in 62 patients of study group and 18 of control group.Regaining consciousness at days 4-7 after surgery was found in 76 patients of study group and 22 of control group.Regaining consciousness at days 8-15 days after surgery was found in 26 patients of study group and 29 of control group.Regaining consciousness over 15 days after surgery was found in 10 patients of study group and 12 of control group.Postoperative unconsciousness including death was found in 25 patients of study group and 23 of control group (P ＜ 0.05).The hospitalization duration was (19.5 ± 1.1) days in study group and (22.8 ± 2.8) days in control group (P ＜ 0.05).No cranial cavity infection was found in study group,while cranial cavity infection occurred in one patient in control group.According to the GOS,the outcome in study group was good in 133 patients,moderate to severe disability in 41,vegetative state in 7 and death in 18,while the outcome in control group was good in 34 patients,moderate to severe disability in 47,vegetative state in 9 and death in 14 (P ＜ 0.05).Conclusion The minimally invasive puncturation via the hard tunnel to remove the hematoma is capable of reducing the intracranial pressure before craniotomy for acute subdural hematoma combined with cerebral hernia,can decrease the disability rate and hence is prioritized to clinical application.

Contralateral Superior Cerebellar Artery Syndrome: A Consequence of Brain Herniation

Vascular compromise is a well-known consequence of brain herniation syndromes. Transtentorial brain herniation most often involves posterior cerebral arteries. However, isolated involvement of contralateral superior cerebellar artery (SCA) during unilateral impending brain herniation is reported only once and we present another case of this exceedingly rare entity. A 24-year-old man was referred to us with impending herniation due to a multiloculated hydrocephalus, and during the course of illness, he developed an isolated SCA ischemia in the opposite side of the most dilated entrapped horn. In the current article we discuss the probable pathophysiologic mechanisms of this phenomenon, as well as recommending more inclusive brain studies in cases suspected of Kernohan-Woltman notch phenomenon in unilateral brain herniation. The rationale for this commentary is that contralateral SCA transient ischemia or infarct might be the underdiagnosed underlying pathomechanism of ipsilateral hemiparesis occurring in many cases of this somehow vague phenomenon.

Application of inferior temporal muscle bone flap craniotomy in hypertensive cerebral hemorrhage patients with early hernia / 中国综合临床

Objective To explore the therapeutic effects of two kinds of operation mode of inferior temporal muscle bone flap craniotomy and traditional big bone flap craniotomy in treatment of hypertensive cerebral hemorrhage patients with early cerebral hernia?Methods Sixty?four cases patients of hypertensive cerebral hemorrhage with early cerebral hernia,treated in Huxi Hospital Affiliated to Jining Medical College from January 2011 to January 2015 were randomly divided into observation group ( 32 patients underwent temporal muscle bone flap craniotomy) and control group ( 32 patients underwent traditional big bone flap craniotomy)?The incidence rate of complications,mortality within 3 months,the excellent rate of GOS score on 6 months after the onset were compared?Results The mortality rate of 3 months after operation in the observation group was 9?4%( 3/32) ,in the control group was 12?5%( 4/32) ,the difference between the two groups was not significant (χ2=0?00(correction),P>0?05))?There were 7 cases had severe complications in the observation group,the incidence rate was 21?9%( 7/32 );there were 16 patients had serious complications in control group, the incidence rate was 50%( 16/32) ,the difference was statistically significant between the two groups(χ2=5?50,P<0?05)?There were 7 cases recovered well,8 cases were residual,the excellent rate of GOS score was 46?9%( 15/32) in the observation group;there were 4 cases recovered well,3 cases were residual,the excellent rate of GOS score 21?9%( 7/32) in the control group,the difference was statistically significant(χ2=4?27,P<0?05)?Conclusion For patients with hypertensive cerebral hemorrhage in basal ganglia region in the early stage of cerebral hernia,temporal muscle bone flap craniotomy hematoma removal can also effectively relieve the hernia, compared with traditional big bone flap craniotomy, can significantly reduce the incidence of complications, improve the prognosis of the patients.

Emergent treatment of severe traumatic intracranial hematoma with minimally invasive technique / 中华急诊医学杂志

Objective To evaluate the value of minimally invasive technique in treatment of severe traumatic intracranial hematoma at emergency department.Method From January 1995 to December 2005,126 patients were treated by using the minimally invasive technique in Affiliated Chaoyang hospital once patients were diagnosedas severe traumatic cerebral hernia resulted from intracranial hematoma and also those whose clinical data were retrospectively analyzed.In the emergency department,the per-operative plan was done according to the CT imaging,including the sute of burr hole on the skull,the direction and depth of carmulation,and the drainage cannula was put into the hematoma cavity for external drainage under local anesthesia.Results The successful rate of puncture was 100%.The patients's dukated oyouk contracted immediately after drainage.There are 79/ 95 patients(83.1%)had single pupil dilated and 17/31(54.8%)patients had bilateral pupils dilated.The immediately clinical effective was 76.2%.According to Glasgow outcome scale,43 of 126 patients had good recovery,26 had moderate deficits and 18 had severe sequelae,16 patients were in vegetative state,18 died. Conclusions Clinical prospective study proves that minimally invasive technique can ameliorate the cerebral hernia,prolong the operative therapie window time.

OTOGENOUS CEREBRAL HERNIA ——ANALYSIS OF 25 CASES / 重庆医科大学学报

This paper reports 25 cases with otogenous cerebral hernia, in which, 13 were tentorial hernia, (10 inferior tentorid notch hernia, 3superior tentorid notch hernia), 12 tonsillar hernia. We found that the predisposing factors of cerebral hernia were mastaidotomy Inmbal puncture, postural change and drainage of cerebral puneture, etc.Whenever the cerebral pressure of a patient with cerebral abscess is increased, one should avoid aforesaid factors in order to avoid the emergence of cerebral hernia incarceration.It is emphasized that once cerebral hernia emerged in patient. a measure of dehydrant should be taken as a preparatory step before opration