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1.
Rev. Assoc. Med. Bras. (1992) ; 68(1): 37-43, Jan. 2022. tab, graf
Article in English | LILACS | ID: biblio-1360694

ABSTRACT

SUMMARY OBJECTIVE: This study aimed to develop and validate a practical nomogram to predict the occurrence of post-traumatic hydrocephalus in patients who have undergone decompressive craniectomy for traumatic brain injury. METHODS: A total of 516 cases were enrolled and divided into the training (n=364) and validation (n=152) cohorts. Optimal predictors were selected through least absolute shrinkage and selection operator regression analysis of the training cohort then used to develop a nomogram. Receiver operating characteristic, calibration plot, and decision curve analysis, respectively, were used to evaluate the discrimination, fitting performance, and clinical utility of the resulting nomogram in the validation cohort. RESULTS: Preoperative subarachnoid hemorrhage Fisher grade, type of decompressive craniectomy, transcalvarial herniation volume, subdural hygroma, and functional outcome were all identified as predictors and included in the predicting model. The nomogram exhibited good discrimination in the validation cohort and had an area under the receiver operating characteristic curve of 0.80 (95%CI 0.72-0.88). The calibration plot demonstrated goodness-of-fit between the nomogram's prediction and actual observation in the validation cohort. Finally, decision curve analysis indicated significant clinical adaptability. CONCLUSION: The present study developed and validated a model to predict post-traumatic hydrocephalus. The nomogram that had good discrimination, calibration, and clinical practicality can be useful for screening patients at a high risk of post-traumatic hydrocephalus. The nomogram can also be used in clinical practice to develop better therapeutic strategies.


Subject(s)
Humans , Decompressive Craniectomy/adverse effects , Brain Injuries, Traumatic/surgery , Brain Injuries, Traumatic/complications , Hydrocephalus/surgery , Hydrocephalus/etiology , Hydrocephalus/epidemiology , Cohort Studies , Nomograms
2.
Salud UNINORTE ; 37(2): 264-284, mayo-ago. 2021. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1377249

ABSTRACT

RESUMEN Objetivos: El propósito de este estudio fue determinar el desenlace en el egreso y en el seguimiento a un año de los pacientes con trauma craneoencefálico severo sometidos a craniectomía descompresiva primaria y secundaria en la Clínica de la Universidad de La Sabana, en un periodo de cinco años. Pacientes y métodos: Se llevó a cabo una serie de casos retrospectiva de pacientes con trauma craneoencefálico severo sometidos a craniectomía descompresiva entre 2008 y 2013. Los desenlaces primarios fueron la sobrevida y el estado funcional medido por la escala de desenlace de Glasgow al momento del egreso hospitalario y al año de seguimiento. Como desenlaces secundarios se incluyeron el tiempo de latencia para la realización de la craniectomía, las complicaciones intra- y postoperatorias, días de hospitalización y estancia en la unidad de cuidados intensivos, tiempo de ventilación, resultados de la craneoplastia y causa de muerte. Resultados: Treinta y cinco pacientes con trauma craneoencefálico severo fueron sometidos a craniectomía descompresiva en el periodo de estudio, 29 primarias y 6 secundarias, con una latencia mediana de 5 horas y 57 horas, respectivamente. Se observó una sobrevida del 51,4 % de los pacientes, de los cuales 39 % presentó recuperación funcional satisfactoria en la escala de desenlace de Glasgow en el momento del egreso y al año. Conclusiones: En este grupo de pacientes sometidos a craniectomía descompresiva primaria o secundaria, junto con un manejo interdisciplinario y rehabilitación precoz, se presentaron desenlaces funcionales favorables en el seguimiento a largo plazo.


ABSTRACT Aim: The purpose of this study was to determine the outcome, at discharge and at one-year follow-up, of patients with severe traumatic brain injury undergoing primary and secondary decompressive craniectomy at Clinica Universidad de La Sabana, over a period of five years. Patients and methods: We conducted a retrospective case series of patients with severe traumatic brain injury undergoing decompressive craniectomy between 2008 and 2013. Te primary outcomes were survival and functional status, measured by the Glasgow Outcome Scale, both at discharge, and at the one year follow-up. Secondary outcomes included latency time for craniectomy, intra and postoperative complications, days of hospitalization and intensive care unit stay, ventilation time, cranioplasty results, and cause of death. Results: Thirty-five patients with severe traumatic brain injury underwent decompressive craniectomy in the study period, 29 of which were primary and 6, secondary, with a median latency of 5 hours and 57 hours, respectively. A survival of 51.4% of the patients was observed, of which 39% presented satisfactory functional recovery on the Glasgow outcome scale at the time of discharge and one year later. Conclusions: In this group of patients who underwent primary or secondary decompressive craniectomy, together with interdisciplinary management and early rehabilitation, favorable functional outcomes were found in the long-term follow-up.

3.
Acta cir. bras ; 36(4): e360406, 2021. tab, graf
Article in English | LILACS | ID: biblio-1248544

ABSTRACT

ABSTRACT Purpose To evaluate the effects of controlled decompression and rapid decompression, explore the potential mechanism, provide the theoretical basis for the clinical application, and explore the new cell death method in intracranial hypertension. Methods Acute intracranial hypertension was triggered in rabbits by epidural balloon compression. New Zealand white rabbits were randomly put into the sham group, the controlled decompression group, and the rapid decompression group. Brain water content, etc., was used to evaluate early brain injury. Western blotting and double immunofluorescence staining were used to detect necroptosis and apoptosis. Results Brain edema, neurological dysfunction, and brain injury appeared after traumatic brain injury (TBI). Compared with rapid decompression, brain water content was significantly decreased, neurological scores were improved by controlled decompression treatment. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining and Nissl staining showed neuron death decreased in the controlled decompression group. Compared with rapid decompression, it was also found that apoptosis-related protein caspase-3/ tumor necrosis factor (TNF)-a was reduced markedly in the brain cortex and serum, and the expression levels of necroptosis-related protein, receptor-interacting protein 1 (RIP1)/receptor-interacting protein 1 (RIP3) reduced significantly in the controlled decompression group. Conclusions Controlled decompression can effectively reduce neuronal damage and cerebral edema after craniocerebral injury and, thus, protect the brain tissue by alleviating necroptosis and apoptosis.


Subject(s)
Brain Injuries , Intracranial Hypertension , Rabbits , Rats, Sprague-Dawley , Apoptosis , Decompression , Necroptosis
4.
Article in Chinese | WPRIM | ID: wpr-909184

ABSTRACT

Objective:To investigate the efficacy and safety of short-term deep sedation after conventional decompressive craniotomy with hematoma removal in patients with hypertensive intracerebral hemorrhage.Methods:Sixty patients with hypertensive intracerebral hemorrhage who underwent conventional decompressive craniotomy with hematoma removal in the People′s Hospital of Yueqing, China between March 2018 and May 2019 were included in this study. They were randomly divided into deep sedation and light sedation groups ( n = 30/group). The deep sedation group was administered propofol (0.6-1.2 mg/kg/h) combined with sedate fentanyl to achieve the level of sedation to Richmond Agitation-Sedation Scale (RASS) -3 to -4 points and to the level of pain to Critical Care Pain Observation Tool (CPOT) 0-1 point. The duration of sedation and analgesia was for 48 hours. The light sedation group was administered propofol (0.2-0.5 mg/kg/h) combined with sedate fentanyl to achieve the level of sedation to RASS -1 to -2 points and to the level of pain to CPOT 0-1 point. The duration of sedation and analgesia was rehemorrhage for 48 hours. Patients in the two groups were intravenously administered Urapidil to control blood pressure to be 120-160/60-90 mmHg. In addition, all patients were subjected to mechanical ventilation, dehydration, reduction of intracranial pressure, anti-infection and symptomatic treatment. At 0, 6, 12, 24 and 48 hours after surgery, heart rate, mean arterial pressure, intracranial pressure, recurrence of hemorrhage, ventilator-associated pneumonia, lower extremity deep venous thrombosis, and gastrointestinal bleeding were monitored. Results:At 6, 12, 24 and 48 hours after surgery, the heart rate, mean arterial pressure, and intracranial pressure in the deep sedation group were significantly lower than those in the light sedation group ( P < 0.05 or P < 0.01). The recurrence of rehemorrhage and the incidence of gastrointestinal bleeding in the deep sedation group were 3.33% (1/30) and 6.67% (2/30), respectively, which were significantly lower than those in the light sedation group [10.00% (3/30), 20.00% (6/30), χ2 = 1.071, 2.307, both P < 0.05). There were no significant incidences in ventilator-associated pneumonia [30.00% (9/30) vs. 23.30% (7/30), χ2 = 0.340, P > 0.05] and lower extremity deep venous thrombosis [10.00% (3/30) vs. 6.67% (2/30), χ2 = 0.340, P > 0.05]. Conclusion:Short-term deep sedation after conventional decompressive craniotomy with hematoma removal can lower the heart beat, mean arterial pressure, intracranial pressure, the postoperative recurrence of hemorrhage, and the incidence of gastrointestinal bleeding in patients with hypertensive cerebral hemorrhage.

5.
Chinese Journal of Traumatology ; (6): 328-332, 2021.
Article in English | WPRIM | ID: wpr-922351

ABSTRACT

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.


Subject(s)
Adult , Aged , Aged, 80 and over , Altitude , China , Decompressive Craniectomy , Drainage , Encephalocele/surgery , Hematoma , Humans , Intracranial Hemorrhage, Hypertensive/surgery , Middle Aged , Prognosis , Punctures , Retrospective Studies , Treatment Outcome
6.
Arq. bras. neurocir ; 39(3)15/09/2020.
Article in English | LILACS-Express | LILACS | ID: biblio-1362402

ABSTRACT

Introduction Traumatic brain injury (TBI) is a major cause of mortality around the world. Few advances regarding surgical approaches have been made in the past few years to improve its outcomes. Microsurgical cisternostomy is a well-established technique used in vascular and skull base surgery and recently emerges as a suitable procedure with lesser costs and morbidity when compared with decompressive craniectomy in patients with diffuse TBI. This study aims to describe the technique, indications, and limitations of cisternostomy and to compare it with decompressive craniectomy (DC). Methods A prospective study is being conducted after obtaining approval of the local human ethics research committee. Once the inclusion and exclusion criteria are applied, the patients are submitted to microsurgical cisternostomy, pre and postoperative neurological status and brain computed tomography (CT) evaluation. A detailed review was also performed, which discusses diffuse TBI, DC, and cisternostomy for the treatment of TBI. Results Two patients were submitted to cisternostomy after TBI and the presence of acute subdural hematoma and hugemidline shift at admission computed tomography. The surgery was authorized by the family (the informed consent form was signed). Both patients evolved with a good recovery after the procedure, and had a satisfactory control brain CT. No further surgeries were required after the initial cisternostomy. Conclusions Cisternostomy is an adequate technique for the treatment of selected patients affected by diffuse TBI, and it is a proper alternative to DC with lesser costs and morbidity, since a single neurosurgical procedure is performed. A prospective study is being conducted for a better evaluation and these were the initial cases of this new protocol.

7.
Article | IMSEAR | ID: sea-213221

ABSTRACT

Background: Decompressive craniectomy is the surgical procedure to reduce intracranial pressure, refractory to medical measures. We have described our experience associated with the clinical profile, radiological profile, postoperative status and long term outcome in patients with malignant middle cerebral artery (MCA) territory infarct.Methods: Data were collected from patients who underwent hemispheric decompressive craniectomy for malignant MCA territory infarct in our hospital from May 2014 to June 2019. Clinical, radiological, surgical profile and long term outcome were studied.Results: There were a total of 51 patients aged between 28 years to 76 years. Hypertension (70%) was the most common comorbidity associated. All the patients had at least one focal neurological deficit at the time of presentation. Mean time from the first symptoms to surgery was 2.4 days (about 58 hours). 7 patients died within one month of the surgery. Two third improved objectively within 1 month of surgery. Out of 44 patients, who survived beyond one month, none of the patients were functionally independent after one year of surgery (modified Rankin scale (mRS) of 0 or 1). The patients had a mean mRS of 3.8 at one year.Conclusions: Over several decades decompressive craniectomy has been found to be the most effective measure to reduce mortality and morbidity associated with malignant MCA territory infarct. Early surgery (<48 hours) in patients with good Glasgow Coma scale score reduces the mortality. Larger multicentric trials are required to look at the long term effect on morbidity and mortality.

8.
Arq. neuropsiquiatr ; 78(6): 349-355, June 2020. tab, graf
Article in English | LILACS | ID: biblio-1131709

ABSTRACT

ABSTRACT Background: Malignant infarction of the middle cerebral artery (MCA) occurs in a subgroup of patients with ischemic stroke and early decompressive craniectomy (DC) is one of its treatments. Objective: To investigate the functional outcome of patients with malignant ischemic stroke treated with decompressive craniectomy at a neurological emergency center in Northeastern Brazil. Methods: Prospective cohort study, in which 25 patients were divided into two groups: those undergoing surgical treatment with DC and those who continued to receive standard conservative treatment (CT). Functionality was assessed using the modified Rankin Scale (mRS), at follow-up after six months. Results: A favorable outcome (mRS≤3) was observed in 37.5% of the DC patients and 29.4% of CT patients (p=0.42). Fewer patients who underwent surgical treatment died (25%), compared to those treated conservatively (52.8%); however, with no statistical significance. Nonetheless, the proportion of patients with moderate to severe disability (mRS 4‒5) was higher in the surgical group (37.5%) than in the non-surgical group (17.7%). Conclusion: In absolute values, superiority in the effectiveness of DC over CT was perceived, showing that the reduction in mortality was at the expense of increased disability.


RESUMO Introdução: O infarto maligno da artéria cerebral média (ACM) ocorre em um subgrupo de pacientes com acidente vascular cerebral (AVC) isquêmico e a craniectomia descompressiva (CD) precoce é um de seus tratamentos. Objetivo: Investigar o desfecho funcional de pacientes com acidente vascular cerebral isquêmico maligno submetidos à craniectomia descompressiva em um centro de emergência neurológica do nordeste do Brasil. Métodos: Nesta coorte prospectiva, os pacientes foram divididos em dois grupos: aqueles submetidos a tratamento cirúrgico com craniectomia descompressiva (CD) e aqueles que mantiveram tratamento conservador (TC) padrão. A funcionalidade foi avaliada por meio da Escala de Rankin modificada (ERm) ao final de seis meses de seguimento. Resultados: Evidenciou-se desfecho favorável (ERm≤3) em 37,5% dos pacientes craniectomizados e em 29,4% dos pacientes não craniectomizados (p=0,42). A mortalidade foi menor no grupo de pacientes que se submeteram a tratamento cirúrgico (25%) do que entre aqueles tratados conservadoramente (52,8%), porém sem significância estatística. Por outro lado, a proporção de pacientes com incapacidade moderada a grave (ERm 4‒5) foi maior no grupo cirúrgico (37,5%) do que no grupo não cirúrgico (17,7%). Conclusão: Em valores absolutos, percebeu-se superioridade na eficácia do tratamento cirúrgico sobre o conservador, mostrando que a redução de mortalidade se dá à custa de aumento da incapacidade funcional.


Subject(s)
Humans , Stroke/surgery , Decompressive Craniectomy , Brazil , Prospective Studies , Treatment Outcome , Infarction, Middle Cerebral Artery/surgery , Infarction, Middle Cerebral Artery/diagnostic imaging
9.
Fisioter. Bras ; 21(1): 39-48, mar 8, 2020.
Article in Portuguese | LILACS | ID: biblio-1282569

ABSTRACT

Introdução: A craniectomia descompressiva (CD) é o procedimento cirúrgico capaz de reduzir a mortalidade em pacientes com edema cerebral secundário a um AVE maligno, porém não garante a recuperação funcional. Objetivo: Descrever o perfil clínico e funcional de pacientes submetidos a CD durante o tempo de internação hospitalar. Métodos: Estudo transversal realizado em uma Unidade de Acidente Vascular Cerebral (U-AVC) no período de setembro de 2018 a março de 2019. Coletaram-se dados sociodemográficos, estudo detalhado dos prontuários e dados referentes à funcionalidade, incapacidade e alcances funcionais por meio de questionários e avaliação física e neurológica. Resultados: A amostra foi composta por 21 participantes. A maioria do sexo masculino, idade média de 55±10 anos, casados, baixa escolaridade, exerciam algum tipo de atividade remunerada com renda de um a dois salários mínimos. Os fatores de risco mais prevalentes foram hipertensão arterial sistêmica, tabagismo, etilismo, sedentarismo e sobrepeso. Durante o período de internação hospitalar, a maioria dos pacientes evoluiu com altos índices de incapacidade e baixos níveis de independência e funcionalidade cognitiva e motora. Conclusão: Além de apresentarem combinações de diferentes fatores de risco relacionados ao desenvolvimento de AVE, a maioria dos pacientes avaliados apresentaram altos índices de incapacidade e baixos níveis de independência e funcionalidade, necessitando de assistência máxima ou total para realizar a maioria de suas atividades de vida diária. (AU)


Introduction: Decompression craniectomy (DC) is a surgical procedure that can reduce mortality in patients with cerebral edema secondary to malignant stroke, but does not guarantee functional recovery. Objective: To describe the clinical and functional profile of patients undergoing DC during their hospital stay. Methods: It is a cross-sectional study conducted in a Stroke Unit from September 2018 to March 2019. Sociodemographic data, detailed study of medical records, and data on functionality, disability and functional range were collected through questionnaires and physical and neurological evaluation. Results: The sample consisted of 21 participants. Most were male, mean age 55 ±10 years, married, with low education, had paid activity with income of one to two minimum wages. The most prevalent risk factors were systemic arterial hypertension, smoking, alcoholism, physical inactivity and overweight. During hospitalization, most patients evolved with high levels of disability and low levels of independence and cognitive and motor functionality. Conclusion: In addition to presenting combinations of different risk factors related to the development of stroke, most of the patients evaluated had high levels of disability and low levels of independence and functionality, requiring maximum or total assistance to develop most of their daily living activities. (AU)


Subject(s)
Humans , Stroke , Decompressive Craniectomy , Physical Therapy Modalities , Independent Living
10.
Article in Chinese | WPRIM | ID: wpr-865442

ABSTRACT

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.

11.
Article in Chinese | WPRIM | ID: wpr-799157

ABSTRACT

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.

12.
Article in Chinese | WPRIM | ID: wpr-754835

ABSTRACT

To evaluate the accuracy of transcranial color‐code sonography ( TCCS) in non‐invasive assessment of intracranial pressure( ICP ) . TCCS was used to monitor the cerebral hemodynamic parameters of patients with acute severe traumatic brain injury after decompressive craniectomy and make estimation of the non‐invasive intracranial pressure ( ICPtccs) . Methods A total of 91 patients with acute severe traumatic brain injury involved in this retrospective study were divided into the ICP normal group( ≤22 mm Hg ) and the ICP increased group ( >22 mm Hg ) . T he correlation and consistency of middle cerebral artery blood flow parameters and ICPtccs with invasive intracranial pressure ( iICP ) were analyzed . According to Glasgow score ( GCS) ,Patients( GCS 3-8) were divided into acute extremely severe traumatic brain injury( GCS 3 -5) and acute severe traumatic brain injury ( GCS 6 -8 ) . A comparison was made of ROC ( ICPtccs) curve and the area under the curve( AUC) between the two groups were cornpared . Results①No statistical differences were found in cerebral hemodynamic parameters between the side with and without decompressive craniectomy in patients with acute severe traumatic brain injury ( all P >0 .05 ) . ②M onitored resistive index ( RI) ,pulsatility index ( PI) and ICPtccs between the normal ICP group and the increased ICP group showed statistically significant differences ( all P < 0 .05 ) ,w hile monitored systolic velocity ,diastolic velocity and mean velocity presented no statistically significant difference ( all P >0 .05) . T he correlations between RI ,PI with iICP were low ( r= 0 .247 ,0 .221 ; all P < 0 .05 ) ,w hile there was a moderate correlation between ICPtccs and iICP( r =0 .417 , P <0 .001 ) . ③Bland‐Altman plot showed an overestimation of 2 .3 mm Hg ( 95% CI 0 .00-4 .59 mm Hg ) for ICPtccs compared to iICP . ④T he AUC of Glasgow score ( GCS 3-5 and GCS 6-8) in the two groups were 0 .759 ,0 .781 ( all P <0 .05) . All the cut‐off points of ICPtccs were 19 mm Hg ,with a sensitivity of 83 .33% ,81 .82% and a specificity of 64 .86% , 75 .68% ,respectively . Pairwise comparison of two AUCs showed no statistical difference ( P = 0 .476) . ICPtccs presented the same ability to estimate ICP in patients with acute severe and extremely severe traumatic brain injury . TCCS could accurately assess the elevation of ICP in 72 .52% patients with acute severe traumatic brain injury . Conclusions TCCS can be used as a non‐invasive screening tool to assess w hether ICP of patients with acute severe traumatic brain injury is elevated and to semi‐quantitatively estimate ICP ,showing useful clinical value .

13.
Journal of Chinese Physician ; (12): 705-709,714, 2019.
Article in Chinese | WPRIM | ID: wpr-754215

ABSTRACT

Objective To systematically evaluate the efficacy and safety of craniotomy and decompressive craniectomy in the treatment of acute subdural hematoma.Methods A systematic search was performed in PubMed,EMbase,the Cochrane Library,Web of science,China National Knowledge Infrastructure (CNKI),WanFang Data,and CBM databases up to June 2018 for the studies that provided comparisons between craniotomy hematoma evacuation and decompressive craniectomy for acute subdural hematoma.For the two categorical variables,the Odds Ratio (OR) and its 95% Confidence Interval (95% CI) are used.Two researchers independently screened the literature,extracted the data,and evaluated the risk of bias of the included studies.The meta analysis was performed using Stata/SE 12.0 software.Results A total of 8 studies were included in the meta analysis,of which 828 patients underwent craniotomy,and 663 patients underwent decompressive craniectomy.Meta analysis results showed that patients receiving decompressive craniectomy had a significantly lower Glasgow Coma Scale (GCS) when they first had symptoms.The residual rate of acute subdural hematoma in the decompressive craniectomy group was significantly lower than that in the craniotomy group (P =0.015),but there was no significant difference in the rate of reoperation.The incidence of poor outcome at following was lower in the craniotomy group compared with decompressive craniectomy group (50.1% vs 60.1%;P =0.003).Similarly,the mortality of the craniotomy group was lower than that of the decompressive craniectomy group (P =0.002).Conclusions Decompressive craniectomy may be the first choice for acute subdural hematoma,but the study is influenced by many factors and is not sufficient to provide definitive evidence.

14.
International Journal of Surgery ; (12): 486-490, 2019.
Article in Chinese | WPRIM | ID: wpr-751662

ABSTRACT

Traumatic craniocerebral injury has been paid close attention by neurosurgeons at home and abroad due to its high morbidity and mortality.Cerebral contusion and intracranial hematoma caused by various injury mechanisms are the main causes of increased intracranial pressure in the acute stage of traumatic brain injury.As a classic surgical method,standard decompressive craniotomy,often together with intracranial hematoma evacuation,brain debridement and internal decompression,has become the main surgical treatment in the acute stage of traumatic brain injury,saving the lives of many patients with severe cerebral injury,the importance of this procedure is irreplaceable.In long-term clinical practice,through the unremitting efforts of first-line neurosurgeons and neuroscientists,a large number of studies have been conducted on the relationship between the details,norms and prognosis of craniotomy,so as to better regulate the treatment of traumatic brain injury and reduce the death and disability rate of patients with severe brain injury.This article systematically reviews and analyzes the pathophysiological mechanism of intracranial hypertension and the mechanism,development history,surgical methods,indications and contraindications,prognosis and prospects of the intracranial hypertension.Through this article,the author hope to have some guidance and suggestions for future clinical work.

15.
Chinese Journal of Trauma ; (12): 430-434, 2019.
Article in Chinese | WPRIM | ID: wpr-745075

ABSTRACT

The efficacy of decompressive craniectomy (DC) in reducing traumatic brain injury mortality has been affirmed,but there are also many serious complications.Syndrome of the trephined (ST) and paradoxical herniation (PH) are rare complications.ST is characterized by a series of neurological deterioration due to skin flaps subsidence from weeks to months after DC.These neurological impairments are closely related to the subsequent repair of skull defects.PH shows progressive decrease in consciousness on the basis of ST,changes in pupils on the side of skull defects,low touch pressure at the defect window,and obvious midline shift and brain stem compression on CT.ST and PH have common inducements in pathophysiology,including cerebrospinal fluid dynamics,atmospheric pressure,cerebral blood flow and brain material metabolism.There is no consensus on the diagnosis of ST and PH,and early cranioplasty is suggested in terms of treatment.This article reviews the clinical manifestations,pathophysiological changes,diagnosis and treatment of ST and PH after DC operation,so as to provide references for clinicians to further understand ST and PH.

16.
Chinese Journal of Trauma ; (12): 394-399, 2019.
Article in Chinese | WPRIM | ID: wpr-745070

ABSTRACT

Objective To investigate the efficacy of step decompression combined with decompressive craniectomy in treating severe traumatic brain injury (sTBI).Methods A retrospective case series study was conducted to analyze the clinical data of 192 patients with sTBI admitted to Changsha Traditional Chinese Medicine Hospital from January 2016 to April 2018.There were 149 males and 43 females,aged 11-79 years,with an average of 50.1 years.The Glasgow coma score (GCS) was 7-8 points in 57 patients,5-6 points in 45 patients,and 3-4 points in 90 patients.There were 55 patients with unilateral pupil dilation and 88 patients with bilateral pupil dilation.All patients were treated with step decompression and decompressive craniectomy.GCS and pupil sizes before and after operation,intraoperative diffuse brain swelling and acute encephalocele,intraoperative and postoperative delayed bleeding,secondary surgery,mortality during hospitalization,and Glasgow outcome score (GOS) 6 months after injury were recorded.Results At 24 hours after operation,the GCS was 7-8 points in 87 patients,5-6 points in 51 patients,and 3-4 points in 54 patients.The consciousness was significantly improved (P < 0.01),and the pupil was reduced in 56 patients (P < 0.0l).There were four patients with diffuse brain swelling during operation (2.1%),11 patients with acute encephalocele (5.7%),seven patients with delayed bleeding (3.6%),27 patients with postoperative delayed bleeding (14.1%),17 patients receiving secondary surgery (9.7%).Thirty-eight patients died during hospitalization (19.8%).The results of GOS follow-up of 6 months were as follows:there were 50 patients with good recovery (30.0%),36 patients with moderate disability (24.5%),15 patients with severe disability (10.2%),46 patients with persist vegetative states (31.3%),and seven patients died (4.8%).Conclusion For sTBI patients,step decompression combined with decompressive craniectomy can significantly reduce intraoperative diffuse brain swelling and encephalocele,intraoperative,and postoperative delayed bleeding,thus improving the prognosis.

17.
Chinese Journal of Trauma ; (12): 389-393, 2019.
Article in Chinese | WPRIM | ID: wpr-745069

ABSTRACT

Objective To investigate the effect of cisternostomy on the prognosis of patients with traumatic brain injury (TBI).Methods A retrospective case control study was conducted to analyze the clinical data of 46 patients with TBI admitted to Shanxi Dayi Hospital from May 2017 to September 2018.There were 37 males and nine females,aged 24-80 years [(49.8 ± 15.7)years].The injury severity score (ISS) was 6-42 points [(25.0 ± 8.2)points],and the Glasgow Coma score (GCS) was 3-14 points [(3.4 ± 1.7) points].Twenty-three patients underwent routine surgery only (control group),and 23 patients underwent cisternostomy (cisternostomy group) on the basis of routine surgery.Intracranial pressure monitoring was performed in both groups before surgery.The postoperative intracranial pressure,intracranial pressure 1 week after operation,postoperative mechanical ventilation time,neurosurgical ICU (NICU) time,postoperative dehydration dose,decompressive craniectomy rate,postoperative infection rate,mortality rate,length of hospital stay,GCS at discharge,and Glasgow outcome score (GOS) of 3 months of follow-up were compared between the two groups.Results Compared with the control group,the cistemostomy group had lower postoperative intracranial pressure [(7.1 ± 5.7) mmHg vs.(14.2 ± 12.0) mmHg)],intracranial pressure 1 week after operation [(11.8 ± 0.5) mmHg vs.(14.0 ± 0.7) mmHg],postoperative dosage of dehydrating agent [0 (0-500.0) ml vs.1 275 (787.5-3 812.5) ml] and decompression rate (57% ∶ 91%) (P < 0.05).There were no significant differences between the cistemostomy group and control group in postoperative mechanical ventilation time [120 (42.0-225.0)hours vs.89(65.5-203.5)hours],NICU time [236(182.0-340.5)hoursvs.281 (114-400)hours],postoperative infection rate (4% vs.0),mortality rate (13% vs.39%) and hospital stay [32 (20.0-44.5) hours vs.25 (12.0-30.5)hours] (P > 0.05).The cisternostomy group had higher GCS score at discharge than the control group [(10.7 ± 4.2) points vs.(7.9 ± 4.2) points] (P < 0.05).After 3 months of follow-up,18 patients in the cisternostomy group showed good prognosis,better than that in the control group (11 patients) (P < 0.05).Conclusion For TBI patients,cisternostomy can clear the blood cerebrospinal fluid,reduce harmful metabolic products in the brain,reduce intracranial pressure and hence improve the prognosis of patients.

18.
Chinese Journal of Trauma ; (12): 385-388, 2019.
Article in Chinese | WPRIM | ID: wpr-745068

ABSTRACT

Skull defect is one of the major sequelae of traumatic brain injury and decompressive craniectomy,which affects the prognosis of neurological function.Cranioplasty is the main method to treat skull defect.The surgical technique is relatively simple and has been widely performed in neurosurgical departments.Although the optimal timing of cranioplasty is still controversial,the author advocates early cranioplasty when the patent's condition permits.Different cranioplasty materials have their own advantages and disadvantages,so we should choose appropriate materials according to the specific conditions of patients.Full preoperative evaluation,reasonable operation and proper postoperative management are important means to prevent complications related to cranioplasty.In view of these problems,the author reviews the latest literature and progress in order to provide reference for standardizing clinical treatment.

19.
Chinese Journal of Trauma ; (12): 221-226, 2019.
Article in Chinese | WPRIM | ID: wpr-745045

ABSTRACT

Objective To investigate the efficacy of decompressive craniectomy (DC) combined with ipsilateral external ventricular drainage (iEVD) for severe traumatic brain injury (sTBI). Methods A retrospective case control study was performed on the clinical data of 54 sTBI patients admitted to the First People's Hospital of Taizhou from January 2015 to March 2018. There were 38 males and 18 females, aged 18-72 years [ (51. 8 ± 15. 4)years]. The Glasgow Coma Scale (GCS) of patients ranged from 3 to 8 points. Among 54 patients, 27 received DC treatment, including 18 males and nine females aged (50. 1 ± 2. 9)years (DC group);27 patients received DC combined with iEVD, including 18 males and nine females aged (53. 4 ± 3. 1) years (DC-iEVD group). Intracranial pressure after surgery and complications ( hydrocephalus and subdural hygroma) 2 weeks after surgery, andModified Rankin Scale (mRS) 3 months after surgery were compared between the two groups. Results All patients were followed up for 2.5-4 months [(3.0 ±0.8)months]. No significant difference was found in intracranial pressure at postoperative 12 hours and 24 hours between the two groups (P>0. 05). However, the intracranial pressure of DC-iEVD group were significantly lower than those of DC group at 36, 48, 60 and 72 hours after operation (P<0. 05). The hydrocephalus incidence 2 weeks after surgery of DC-iEVD group was 15% (4/27), while that of DC group was 7% (2/27)(P >0. 05). The subdural effusion incidence 2 weeks after surgery of DC-iEVD group was 19% (5/27), while that of DC group was 44% (12/27) (P<0. 05). According to mRS, patients with good outcome in DC-iEVD group accounted for 63%(17/27) while the ratio was 44% (12/27) in DC group. The prognosis of DC-iEVD group was slightly better than that of DC group, but the difference was not statistically significant(P>0. 05). Conclusion For sTBI, combined use of DC and iEVD can better control intracranial pressure and reduce the occurrence of subdural effusion.

20.
Article in Chinese | WPRIM | ID: wpr-744514

ABSTRACT

Objective To explore the curative effect of controlled decompression in the treatment of elderly patients with severe craniocerebral injury.Methods The clinical data of 82 patients with severe head injury in the First People's Hospital of Jinzhong were retrospectively analyzed from February 2016 to September 2017.Thirty-seven patients who took the big bone flap decompression for the treatment were selected as control group,and 45 patients who took controlling decompression for the treatment were selected as observation group.The clinical efficacy of the two groups was evaluated.Results The total effective rate of the observation group was 93.33% (42/45),which was higher than 75.68% (28/37) of the control group(x2 =5.068,P < 0.05).The incidence rate of complication of the observation group was 4.44% (2/45),which was lower than 18.92% (7/37) of the control group (x2 =4.354,P <0.05).The Barthel score [(86.8 ± 3.4) points],NCSE score [(84.9 ± 3.6) points] and GCS score [(13.2 ±0.5) points] of the observation group were significantly higher than those of the control group [(78.9 ± 6.7)points,(80.3 ± 5.4) points,(12.6 ± 1.7) points,t =3.908,4.606,2.255,all P < 0.05].Conclusion The curative effect of controlled decompression in the treatment of severe craniocerebral injury is distinct,and it has fewer complications,and can effectively improve the clinical symptoms,the prognosis effect is good.

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