Application of standard decompressive craniectomy in the treatment of traumatic brain injury / 国际外科学杂志

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.

Clinical study of continuous intracranial pressure monitoring after decompressive craniectomy in severe traumatic brain injury patient / 国际外科学杂志

Objective To clarify the relationship between intracranial pressure monitoring and prognosis of patients with traumatic brain injury after decompressive craniectomy.Methods From December 2015 to December 2017,48 head-injured patients in Affiliated Suzhou Hospital of Nanjing Medical University were enrolled,who were underwent decompressive craniectomy in this retrospective study.The patients were subdivided into 2 groups based on whether postoperative was monitored (n =19) or not (n =29).The prognosis was evaluated by Glasgow Outcome Scale score,with 1 point of prognosis death,2 to 3 points of poor prognosis,and 4 to 5 points of good prognosis.Count data were expressed as a percentage (％).Count data were expressed as percentage (％).The chi-square test was used to compare the difference in the rate of good prognosis and mortality between the two groups.Results The mortality of monitoring group (10.5％) was significantly lower than that of control group (37.9％) (x2 =4.365 5,P =0.036 7) during hospitalization,The rate of good prognosis in the monitoring group (68.4％) and the control group (44.8％) was not statistically significant (x2 =2.573 8,P =0.108 6).Condusion The study showed that continuous monitoring in patients with severe craniocerebral injury could reduce the mortality of patients during hospitalization,but had no significant effect on the improvement of prognosis.