Gradual and Controlled Decompression for Brain Swelling Due to Severe Head Injury

被引:0
作者
Yun-Zhao Jiang
Qing Lan
Qi-Hong Wang
Dong-Lei Song
Hua Lu
Wei-Jiang Wu
机构
[1] Wuxi Third People’s Hospital,Department of Neurosurgery
[2] Second Affiliated Hospital of Soochow University,Department of Neurosurgery
[3] Ruijin Hospital of Jiaotong University,Department of Neurosurgery
来源
Cell Biochemistry and Biophysics | 2014年 / 69卷
关键词
Decompressive craniectomy; Intraoperative brain swelling; Duraplasty;
D O I
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中图分类号
学科分类号
摘要
Patients suffering from uncontrollable intracranial hypertension due to posttraumatic brain swelling (BS) generally either die or survive in an extremely disabled state. Decompressive craniectomy (DC) with dural augmentation may be the best method to assist these patients. However, the efficacy of DC on functional outcomes remains controversial. One of the factors contributing to poor outcomes could be intraoperative brain extrusion, which is an acute potential complication of DC. The authors have adopted a new surgical technique for traumatic BS that can prevent and control massive intraoperative BS (IOS). In the past 3 years, the authors have used a unique technique, called “gradual and controlled decompression”, in the treatment of posttraumatic BS. This procedure consists of creating numerous small dural openings and removing clots; enlarging fenestration in the frontal and temporal basal regions to detect and treat brain contusion; making U-shaped, discontinuous, small dural incisions around the circumference of the craniotomy; and performing an augmentation duraplasty through the discontinuous small opening with dural prosthetic substances. This technique has been employed in 23 patients suffering from posttraumatic BS. In all cases, IOS was prevented and controlled through gradual stepwise decompression, and expanded duraplasty was performed successfully. This new surgical approach for posttraumatic BS can prevent severe extrusion of the brain through the craniotomy defect and allows the gradual and gentle release of the subdural space. Further clinical studies should be conducted to estimate the impact of this new technique on morbidity and mortality rates.
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页码:461 / 466
页数:5
相关论文
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