Post-operative expansion of hemorrhagic contusions after unilateral decompressive hemicraniectomy in severe traumatic brain injury
Post-operative expansion of hemorrhagic contusions after unilateral decompressive hemicraniectomy in severe traumatic brain injury
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DOI：
10.1089/neu.2007.0442
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发表时间：
2008-05-01
影响因子：
4.2
通讯作者：
Rosenthal, Guy
中科院分区：
文献类型：
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作者：
Flint, Alexander C.;Manley, Geoffrey T.;Rosenthal, Guy
减压性半颅骨切除术通常用于伴有弥漫性脑肿胀或顽固性颅内压升高的创伤性脑损伤 (TBI) 患者。 TBI 患者出血性挫伤扩大很常见，但去骨瓣减压术后其发生率尚未明确。这项回顾性研究的目的是确定严重 TBI 中单侧半颅骨切除术后出血性挫伤扩张的发生率，确定与挫伤扩张相关的因素，并检查挫伤扩张是否与临床结果恶化相关。对 40 名连续接受去骨瓣减压术的非穿透性 TBI 患者的计算机断层扫描 (CT) 扫描进行了分析。在初次、最后一次术前和术后第一次 CT 扫描时测量出血性挫伤体积。记录死亡率和 6 个月格拉斯哥结果量表 (GOS) 评分。 48% 的患者在初次头部 CT 扫描中出现任何大小的出血性挫伤，但只有 10% 的患者出现总体积 > 5 cc 的出血性挫伤。 58% 的患者在半颅骨切除术后观察到新的或扩大的出血性挫伤>= 5 cc。这些患者的平均出血量为 37.1 +/- 36.3 cc。初次头部 CT 的鹿特丹 CT 评分与去骨瓣减压术后扩大出血性挫伤的发生率和总体积密切相关。即使在控制了年龄和初始格拉斯哥昏迷量表 (GCS) 评分后，半颅骨切除术后扩大的出血性挫伤体积大于 20 cc 与死亡率和 6 个月 GOS 较差密切相关。严重 TBI 后行去骨瓣减压术后，出血性挫伤扩大很常见。半颅骨切除术后出血性挫伤扩张的体积与死亡率和不良预后密切相关。最初 CT 结果的严重程度可以预测半颅骨切除术后挫伤扩大的风险，从而确定可能受益于旨在增强凝血系统的治疗的患者亚组。
Decompressive hemicraniectomy is commonly performed in patients with traumatic brain injury (TBI) with diffuse brain swelling or refractory raised intracranial pressure. Expansion of hemorrhagic contusions in TBI patients is common, but its frequency following decompressive hemicraniectomy has not been well established. The aim of this retrospective study was to determine the rate of hemorrhagic contusion expansion following unilateral hemicraniectomy in severe TBI, to identify factors associated with contusion expansion, and to examine whether contusion expansion is associated with worsened clinical outcomes. Computed tomography (CT) scans of 40 consecutive patients with non-penetrating TBI who underwent decompressive hemicraniectomy were analyzed. Hemorrhagic contusion volumes were measured on initial, last pre-operative, and first post-operative CT scans. Mortality and 6-month Glasgow Outcome Scale (GOS) score were recorded. Hemorrhagic contusions of any size were present on the initial head CT scan in 48% of patients, but hemorrhagic contusions with a total volume of >5 cc were present in only 10%. New or expanded hemorrhagic contusions of >= 5 cc were observed after hemicraniectomy in 58% of patients. The mean volume of increased hemorrhage among these patients was 37.1 +/- 36.3 cc. The Rotterdam CT score on the initial head CT was strongly associated with the occurrence and the total volume of expanded hemorrhagic contusions following decompressive hemicraniectomy. Expanded hemorrhagic contusion volume greater than 20 cc after hemicraniectomy was strongly associated with mortality and poor 6-month GOS even after controlling for age and initial Glasgow Coma Scale (GCS) score. Expansion of hemorrhagic contusions is common after decompressive hemicraniectomy following severe TBI. The volume of hemorrhagic contusion expansion following hemicraniectomy is strongly associated with mortality and poor outcome. Severity of initial CT findings may predict the risk of contusion expansion following hemicraniectomy, thereby identifying a subgroup of patients who might benefit from therapies aimed at augmenting the coagulation system.