文档介绍：外伤性大面积脑梗塞的手术治疗
Surgical management of traumatic extensive cerebral infarction
【Abstract】 Objective To explore the methods and oute of operative treatment of traumatic extensive cerebral Operative opportunity,methods and curative effect in14patients atic extenˉsive cerebral infarction ed addition,9of them received internal and external All of14patients survived and their neural functions reˉcovered to some different Surgical depression is a life-saving maneuver for treating the trauˉmatic extensive cerebral infarction,but it is important to grasp the opportunity and select the suitable operative patients porarily after preoperative reinforced dehydration may have better prognosis.
Key atic cerebral infarction surgical depression prognosis
外伤性大面积脑梗塞是颅脑损伤比较严重的并发症之一,治疗困难,我科于2000~2001年采用减压术治疗14例患者。总结如下。
1 资料与方法
一般资料本组14例,男10例,女4例,年龄28~75岁,平均45岁;致伤原因:车祸伤10例,坠落伤3例,爆炸伤1例。
临床表现所有患者入院时均无脑梗塞表现。首次CT扫描蛛网膜下腔出血9例,颅底骨折伴脑脊液耳漏6例。其中6例患者有不同程度的脑挫裂伤,1例硬膜下血肿,并行血肿清除术。入院后第1~10天,表现为病情一度好转,而后头痛、呕吐加重,或原有意识障碍加深,或由清醒转为昏迷,出现肢体瘫痪,其中4例患者出现小脑幕切迹疝,表现为深昏迷,一侧瞳孔散大,对光反射消失,去大脑强直,头颅CT扫描显示为额颞顶大片状低密度影,占位效应明显。
部位和范围 CT扫描示梗塞区位于优势半球9例,非优势半球5例;梗塞灶位于额颞顶10例,位于颞枕部4例;其中3例有梗塞后出血,梗塞面积约(12~14)cm×(7~9)cm,中线结构侧移≥5mm,基底池受压。
手术方法采取两种手术方法:(1)单纯去大骨瓣减压,以大脑中动脉区梗塞为例,额颞顶部马蹄形或倒问号形切口,注意保留颞浅动脉的完整。大骨瓣开颅,前方位于发