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At present, the most commonly used surgical measures for treatment of severe traumatic brain injury (sTBI) mainly include external ventricular puncture and drainage (EVD), decompressive craniectomy (DC), intracranial hematoma clearance and intracerebral decompression of contusion and laceration. All of these procedures can reduce intracranial pressure (ICP) and mortality, but they have the disadvantage of high postoperative adverse functional outcomes. With further study of glyymphatic system and intracranial microsurgery, some scholars have proposed a new neurosurgical technique: cisternostomy, which could achieve good results in the treatment of some refractory intracranial hypertension patients with sTBI. In this paper, we will summarize the recent advance in cisternostomy in the treatment of sTBI by reviewing the relevant literature at domestic and abroad in recent years, including the systematic evaluation of its pathophysiological basis, surgical techniques, surgical indications and contraindications, and surgical efficacy.
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Objective:To investigate the influences of minimally invasive hematoma removal assisted by stereotaxis technique and conservative treatment in clinical prognoses of patients with small/medium intracerebral hematoma in the basal ganglia.Methods:Sixty-four patients with spontaneous basal ganglia cerebral hemorrhage, admitted to our hospital from March 2020 to March 2021, were enrolled in our study; these patients were randomly divided into surgical group (accepted minimally invasive hematoma removal assisted by stereotaxis technique, n=33) and conservative treatment group ( n=31). The baseline general data and 6 months follow-up data of patients from the 2 groups were compared. The Glasgow outcome scale (GOS) scores, modified Barthel index (MBI), modified Rankin scale (mRS) scores and complications were compared 7 d, 1 month and 6 months after surgery. Results:There were no significant differences in gender, age, and amount of bleeding between the 2 groups ( P>0.05). On the 7 th d of surgery, there were no significant differences in GOS scores, MBI, and mRS scores between the 2 groups ( P>0.05). One month after surgery, there were statistically significant differences in GOS scores, MBI, and mRS scores between the 2 groups ( P<0.05); the good prognosis rate in the surgical group was 78.79% (26/33), and that in the conservative treatment group was 25.81%(8/31), with significant difference ( P<0.05). Six months after surgery, there were significant differences in GOS scores, MBI, and mRS scores between the 2 groups ( P<0.05); the good prognosis rate in the surgical group was 95.7% (29/33), and that in the conservative treatment group was 32.3% (10/31), with significant difference ( P<0.05). The incidence of complications in the surgical group and conservative treatment group was 6.06% and 29.03%, respectively, with significant difference ( P<0.05). Conclusion:Minimally invasive hematoma removal assisted by stereotaxis technique is more conducive to the repair of nerve function in patients with moderate to small cerebral hemorrhage in the basal ganglia than conservative treatment.
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Objective To explore the efficacy and safety of mechanical thrombectomy with Solitaire device in patients with acute basilar artery occlusion (ABAO).Methods The clinical data of 5 patients with ABAO,underwent mechanical thrombectomy with Solitaire stent in our hospital from May 2016 to November 2018,were analyzed retrospectively.The clinical treatment efficacy and safety were recorded.Results All these 5 patients accepted endovascular mechanical thrombectomy successfully;successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] grading 2b or 3) was achieved in 4 patients;the embolus was detached to the distal arteriole in one patient.There was no symptomatic intracranial hemorrhage;one patient accepted decompressive craniectomy resulting from massive infarction of cerebellum.Follow up results 90 d after treatment indicated that 4 patients enjoyed good prognosis (modified Rankin Scale scores:0-3).Conclusion Mechanical thrombectomy with Solitaire device is suggested to be safe and efficient in ABAO patients complying with appropriate operative indications.
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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.
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Objective To explore the treatment of paradoxical herniation after bone flap decompression surgery,and improve people's understanding of paradoxical herniation.Methods From April 2014 to July 2017,the clinical data of 12 patients with paradoxical herniation were retrospectively analyzed.The treatment efficacies of position adjusting,sufficient hydration,and cranioplasty were explored.Results Nine patients (75％) had paradoxical herniation within two weeks of surgery,two(16.67％) developed paradoxical herniation from two weeks to one month of surgery,and one (8.33％) developed paradoxical herniation at two months after operation.But no all the patients had sunken and collapsed skin flap.After position adjusting,sufficient hydration,and cranioplasty,12 patients had periodic improvement;the neurological function of 9 patients accepted cranioplasty recovered obviously.Conclusion Paradoxical herniation is reversible after effective treatments,as position adjusting,sufficient hydration,and cranioplasty,enjoying good results.
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Objective To investigate the value of cerebrospinal fluid drainage after aneurysm clipping in patients with intracranial aneurysm complicated with subarachnoid hemorrhage .Methods 84 intracranial aneurysms patients with subarachnoid hemorrhage were selected ,and they were randomly divided into study group (n =42) and control group (n =42).The control group used simple suture after aneurysm clipping ,the study group was given lumbar cistern drainage by implementation of the dural suture tube after aneurysm clipping .Before and after hydro-cephalus and cerebral vasospasm ,treatment changes of serum insulin-like growth factor 1 (IGF-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) levels were compared between the two groups .Results The incidence rate of hydrocephalus of the study gruop was 4.8%,which was significantly lower than the 14.3% of the control group (χ2 =9.743,P <0.05).The incidence rate of cerebral vasospasm of the study group was 7.1%,which was significantly lower than 19.0% of the control group (χ2 =11.802,P <0.05).The incidence rates of intracranial infection,cerebrospinal fluid leakage and other complications between the two groups had no statistically significant differences (χ2 =2.074,2.125,all P >0.05).The serum levels of IGF-1 and sVCAM-1 between the two groups had no statistically significant differences before operation (t =0.417,0.603,all P >0.05).At the 8th day after oper-ation,the serum levels of sVCAM-1 and IGF-1 of the study group were significantly lower than those of the control group (t =7.335,6.856,all P <0.05).Conclusion After aneurysm clipping,the lumbar cistern drainage tube drainage is beneficial to reduce hydrocephalus and cerebral vasospasm incidence ,inhibit the expression of serum IGF-1,sVCAM-1,with less adverse reactions,it is worthy of application.
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Objective To investigate the application of temporal and frontotemporal puncture or frontotemporal craniotomy for hypertensive intracerebral hemorrhage in basal ganglia region .Methods From January 2013 to April 2017,eighty patients with basal ganglia region hypertensive intracerebral hemorrhage in Shanxi Da Hospital were divided into observation group and control group according to random number table method ,with 40 cases in each group.The two groups were respectively given puncture of temporal and frontal temporal region and craniotomy with frontal and temporal bone flap for evacuation of hematoma and decompression of bone flap .The complications and treatment effect after surgery of the two groups were compared.Results Compared with the control group , the emptying rate of postoperative hematoma 1 day in the observation group was decreased [(60.1 ±9.7)%vs.(81.0 ± 9.9)%,t＝-9.537,P＜0.05];the operation time was shortened [(68.5 ±7.7) min vs.(110.2 ±9.1) min,t＝-22.124,P＜0.05];the use of postoperative mannitol decreased [(672.1 ±84.2) g vs.(1427.2 ±99.6) g,t＝-36.617,P＜0.05];the incidence rate of intracranial pneumatosis in the observation group was increased (7.5%vs. 30.0%,χ2＝6.646,P＜0.05).Conclusion Monitoring of intracranial pressure in lateral ventricles combined with puncture of temporal and frontal temporal region used in hypertensive intracerebral hemorrhage in basal ganglia region is helpful to reduce the surgical trauma and accelerate the recovery of postoperative patients ,and can be widely used.
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Objective To explore the cerebral protective effect of edaravone combined with mild hypothermia in patients with severe craniocerebral injury. Methods 64 patients with severe craniocerebral injury were divided into control groups ( n =21 ) , mild hypothermia groups ( n =22 ) and combination groups ( n =21 ) according to the random number table method. All patients were treated with symptomatic supportive therapy and surgical decompression,and the patients in the mild hypothermia group accepted physical cooling and drugs to maintain a low body temperature, and the patients in the combination group accepted edaravone 30mg on the basis of the mild hypothermia group,1 time every 12 hours,and the course of treatment was lasted for two weeks. The Glasgow coma score(GCS),the degree of brain edema and the Glasgow prognostic score( GOS) were observed in the three groups. Results The GCS scores of the mild hypothermia group and combination group at 7d after admission were (9. 54 ± 1. 26) points and (10. 15 ± 1. 56)points,respectively,which were higher than (7. 58 ± 1. 12) points of the control group,the differences were statistically significant(t=7. 867,12. 232,all P<0. 05),and the GCS score of the combination group was higher than that of the mild hypothermia group(t =7. 986,P <0. 05). The GCS scores of the mild hypothermia group and combination group were (12. 21 ± 1. 47)points and (12. 35 ± 1. 12)points at 14d after admission,which were higher than (10.28 ±2.28)points of the control group,the differences were statistically significant(t=8. 823,9. 066,all P<0. 05). The proportions of mild edema patients in the mild hypothermia group and combination group were 69. 09%,71. 43%,respectively,which were higher than 19. 05% of the control group,the differences were statistically significant(χ2 =9. 019,7. 563,all P<0. 05). The GOS scores of the mild hypothermia group and combination group at discharge were (4. 15 ± 0. 51) points and (4. 51 ± 0. 37) points,respectively,which were higher than (3. 69 ± 0. 61)points of the control group,the differences were statistically significant(t=5. 328,6. 228,all P<0. 05),and the GOS score of the combination group was higher than that of the mild hypothermia group(t=4. 251,P<0. 05). Conclusion The curative effect of edaravone combined with mild hypothermia in the treatment of patients with severe craniocerebral injury is significantly better than conventional therapy and mild hypothermia treatment, and it is conducive to promote the recovery of the nerve function.
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Objective To explore the cerebral protective effect of edaravone combined with mild hypothermia in patients with severe craniocerebral injury. Methods 64 patients with severe craniocerebral injury were divided into control groups ( n =21 ) , mild hypothermia groups ( n =22 ) and combination groups ( n =21 ) according to the random number table method. All patients were treated with symptomatic supportive therapy and surgical decompression,and the patients in the mild hypothermia group accepted physical cooling and drugs to maintain a low body temperature, and the patients in the combination group accepted edaravone 30mg on the basis of the mild hypothermia group,1 time every 12 hours,and the course of treatment was lasted for two weeks. The Glasgow coma score(GCS),the degree of brain edema and the Glasgow prognostic score( GOS) were observed in the three groups. Results The GCS scores of the mild hypothermia group and combination group at 7d after admission were (9. 54 ± 1. 26) points and (10. 15 ± 1. 56)points,respectively,which were higher than (7. 58 ± 1. 12) points of the control group,the differences were statistically significant(t=7. 867,12. 232,all P<0. 05),and the GCS score of the combination group was higher than that of the mild hypothermia group(t =7. 986,P <0. 05). The GCS scores of the mild hypothermia group and combination group were (12. 21 ± 1. 47)points and (12. 35 ± 1. 12)points at 14d after admission,which were higher than (10.28 ±2.28)points of the control group,the differences were statistically significant(t=8. 823,9. 066,all P<0. 05). The proportions of mild edema patients in the mild hypothermia group and combination group were 69. 09%,71. 43%,respectively,which were higher than 19. 05% of the control group,the differences were statistically significant(χ2 =9. 019,7. 563,all P<0. 05). The GOS scores of the mild hypothermia group and combination group at discharge were (4. 15 ± 0. 51) points and (4. 51 ± 0. 37) points,respectively,which were higher than (3. 69 ± 0. 61)points of the control group,the differences were statistically significant(t=5. 328,6. 228,all P<0. 05),and the GOS score of the combination group was higher than that of the mild hypothermia group(t=4. 251,P<0. 05). Conclusion The curative effect of edaravone combined with mild hypothermia in the treatment of patients with severe craniocerebral injury is significantly better than conventional therapy and mild hypothermia treatment, and it is conducive to promote the recovery of the nerve function.
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Objective To observe the prognostic effects of the patients with intracranial saccular aneurysm (Hunt-Hess grade Ⅳ- Ⅴ)first treated conservatively for 12 hours and then with surgical treatment and endovascular treatment. Methods The clinical data of 32 patients with intracranial saccular aneurysm (grade Ⅳ,n = 24 and gradeⅤ,n = 8)Hunt-Hess grade Ⅳ-Ⅴadmitted from January 2012 to January 2014 were analyzed retrospectively. Sixteen of them were treated conservatively for 12 hours in hospital,and then they were treated with surgery or embolization (postpone surgery group)and 16 underwent emergency surgery or embolization (immediate surgery group). The neurological prognosis of the patients was evaluated at 1,3 and 6 months before and after treatment. Results There was no significant difference in Glasgow outcome scores between the postpone surgery group and immediate surgery group at 1 month after treatment (3. 7 ± 1. 4,3. 8 ± 1. 2;t = 1. 372,P > 0. 05);there was no significant difference in Rankin prognostic scores at 3 months after treatment (3. 7 ± 1. 7,3. 6 ± 1. 5;t = 1. 361,P > 0. 05);But there was significant difference in prognostic scores at 6 months after treatment between the two groups (3. 5 ± 1. 5, 4. 2 ± 1. 8;t = 2. 234,P < 0. 05). Conclusion Patients with high grade cystic aneurysmal subarachnoid hemorrhage can be treated with conservative treatment. After 12 hours,endovascular embolization or surgical treatment may be performed. The prognosis at 6 months is better than emergent direct surgery or embolization.