Decompressive Craniectomy and Early Cranioplasty for the Management of Severe Head Injury: A Prospective Multicenter Study on 147 Patients
Decompressive Craniectomy and Early Cranioplasty for the Management of Severe Head Injury: A Prospective Multicenter Study on 147 Patients
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DOI：
10.1016/j.wneu.2010.10.020
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发表时间：
2011-03-01
影响因子：
2
通讯作者：
Bresson, Damien
中科院分区：
文献类型：
--
作者：
Chibbaro, Salvatore;Di Rocco, Fedreico;Bresson, Damien
目的：在严重钝性颅脑损伤患者的急诊护理中，无法控制的高颅内压是发病和死亡的主要原因之一。本研究的目的是评估积极的手术治疗在管理不可控的颅内压升高加上早期颅骨reconstruction.METHODS：这是一个前瞻性研究的一系列147例连续患者，根据相同的协议由五个不同的神经外科单位，严重的头部损伤（格拉斯哥昏迷量表评分25毫米汞柱）在五年期间。所有患者均于急性期行大骨瓣减压及硬脑膜成形术，并于伤后12周内（中位数6周，范围4-12周）行颅骨成形术。术前格拉斯哥昏迷量表评分中位数为6/15（范围3-8/15）。在平均26个月（范围14-74个月）的随访中，14例患者失访，仅133例患者可用于研究。89例（67%，格拉斯哥结局评分为4或5分）患者结局良好，25例（19%，格拉斯哥结局评分为2和3分）患者结局不佳，19例（14%）患者死亡。年轻人（
OBJECTIVE: In emergency care of patients with severe blunt head injury, uncontrollable high intracranial pressure is one of major causes of morbidity and mortality. The purpose of this study was to evaluate the efficacy of aggressive surgical treatment in managing uncontrollable elevated intracranial pressure coupled with early skull reconstruction.METHODS: This was a prospective study on a series of 147 consecutive patients, managed according to the same protocol by five different neurosurgical units, for severe head injuries (Glasgow coma scale score 25 mm Hg) during a five-year period. All patients received a wide decompressive craniectomy and duroplasty in the acute phase, and a cranioplasty was also performed within 12 weeks (median 6 weeks, range 4-12 weeks).RESULTS: The emergency decompressive surgery was performed within 28 hours (median 16 hours, range 6-28 hours) after sustaining the head injury. The median preoperative Glasgow coma scale score was 6/15 (range 3-8/15). At a mean follow-up of 26 months (range 14-74 months) 14 patients were lost to long-term follow-up, leaving only 133 patients available for the study. The outcome was favorable in 89 (67%, Glasgow outcome score 4 or 5), it was not favorable in 25 (19%, Glasgow outcome score 2 and 3), and 19 patients (14%) died. A younger age (