Vascular tunnel construction in the treatment of severe brain swelling caused by trauma and SAH.: (Evidence based on intra-operative blood flow measure)
Vascular tunnel construction in the treatment of severe brain swelling caused by trauma and SAH.: (Evidence based on intra-operative blood flow measure)
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DOI：
10.1179/016164102101199701
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发表时间：
2002-03-01
影响因子：
1.9
通讯作者：
Belán, K
中科院分区：
文献类型：
--
作者：
Csókay, A;Pataki, G;Belán, K
去骨瓣减压术加硬脑膜切开术是治疗严重创伤性脑肿胀的最后手段。虽然该方法成功地减少了颅内压，但在大脑的突出部分发生了部分或全部的血管不足。脑膜功能不全的实际原因很可能是由于硬脑膜边缘和脑组织之间的剪切力和压力力导致供应脑突出的皮质静脉和动脉受到压迫。此外，静脉充血可能会导致大脑突出部分的水肿，从而进一步损害神经元的生存能力。这种新的手术技术包括星形十二指肠切开术和在主要皮质静脉和动脉周围创建血管隧道，目的是使血管不会被硬脑膜或骨缘压迫。术中应用彩色多普勒超声测量保护静脉和非保护静脉的血流量，验证了新的血管隧道技术的有效性。在过去的两年中，28例患者用这种方法进行了手术。1例为蛛网膜下腔出血引起的水肿。所有患者均为重度GCS3或GCS4状态，颅内压>30毫米汞柱。与报告病死率为80%~90%的传统手术和非手术治疗相比，病死率降至40%，恢复率(GOS 4，5)也显著提高。这项技术显着降低了颅内压，防止了进一步的浮肿和血管功能不全。这是由于在十二指肠切开边缘形成的血管隧道保护了脑突出部分的动脉循环和静脉引流。
Decompressive craniectomy with durotomy, is possible as a last resort therapy for severe traumatic brain swelling. Although the method successfully diminishes the ICP, partial or total vascular insufficiency occurs in the herniated part of the brain. The actual cause of the insufficiency is most likely due to the compression of the cortical veins and arteries supplying the herniated brain, caused by shearing and pressure forces between the dural edge and brain tissue. Furthermore venous congestion may induce edema in the protruding parts of the brain, thus further compromising neurone viability. The new surgical technique consists of a stellate type durotomy and the creation of a vascular tunnel around the main cortical veins and arteries, with the aim that the vessels do not become compressed by the dural or bone edge. The effect of the novel vascular tunnel technique was proven by measuring the blood flow of the protected and nonprotected veins with Doppler UH, intra-operatively. In the last two years 28 patients were operated on with this method. One case of edema was caused by SAH. All were in severe GCS 3 or GCS 4 status, with more than 30 mmHg ICP. In comparison with the traditional surgical and nonsurgical treatment, where the reported mortality rates are 80%-90% in these severe cases the mortality rate was reduced to 40%, and recovery (GOS 4, 5) rate also increased significantly. With this technique the ICP was significantly reduced and further edema and vascular insufficiency was prevented. This was due to protection of the arterial circulation and venous drainage of the herniated part of the brain, by the formation of a vascular tunnel at the durotomy edges.