Introduction: Acute post traumatic subdural hematoma is a clinical condition with increased morbidity and mortality despite the developments in neurosurgery and urgent intervention is required to have best clinical ou...Introduction: Acute post traumatic subdural hematoma is a clinical condition with increased morbidity and mortality despite the developments in neurosurgery and urgent intervention is required to have best clinical outcome. We will evaluate hinged craniotomy technique in terms of offering adequate brain decompression plus avoiding removal of bone flap which requires second replacement surgery in comparison to cisternostomy effect. Material and Methods: A prospective study was conducted over 30 patients with traumatic acute subdural hematoma presented to neurotrauma unit in Cairo University hospitals from January 2017 to February 2018, operated by hinged craniotomy plus evacuation of hematoma and duroplasty. We avoid rapping the head with elastic bandage post-operative. Generous subcutaneous dissection (5 - 7 cm) all around skin flap was done routinely. Effect of brain decompression was evaluated by measuring the level of brain in relation to skull in post-operative computerized topography. Results: Twenty-one patients operated with initial GCS less than eight. Ten cases (33%) show that cortical surface in relation to skull bone was at inner table, nine cases (30%) at diploid layer and two cases (6.7%) at outer table in post-operative CT brain. Twenty patients died (66.7%);eight patients (26.6%) became fully conscious and two patients (6.7%) had vegetative outcome. No re-operation was done in any of our patients. Conclusion: Hinged craniotomy may be a safe and effective alternative technique with comparable results to cisternotomy in cases of traumatic brain injury that require decompression to avoid second surgery, especially in centres lacking cisternostomy experience. Although gaining cisternostomy experience may help in other indications, future prospective studies with larger number are required.展开更多
Purpose:Traumatic brain injury(TBI)is a significant public health issue that impacts individuals all over the world and is one of the main causes of mortality and morbidity.Decompressive craniectomy is the usual cours...Purpose:Traumatic brain injury(TBI)is a significant public health issue that impacts individuals all over the world and is one of the main causes of mortality and morbidity.Decompressive craniectomy is the usual course of treatment.Basal cisternostomy has been shown to be highly effective as an alternative procedure to decompressive craniectomy.Methods:We conducted a retrospective cohort of patients who received surgery for severe TBI between January 2019 and March 2023.Inclusion criterias were patients between the ages of 18 and 70 years who met the diagnostic criteria for severe TBI at first presentation and who underwent surgical intervention.The exclusion criteria were patients who have severe multiple injuries at the time of admission;preoperative intracranial pressure>60 mmHg;cognitive impairment before the onset of the disease;hematologic disorders;or impaired functioning of the heart,liver,kidneys,or other visceral organs.Depending on the surgical approach,the patients were categorized into decompressive craniectomy group as well as basal cisternostomy group.General data and postoperative indicators,including Glasgow coma scale,intracranial pressure,etc.,were recorded for both groups of patients.Among them,the Glasgow outcome scale extended assessment at 6 months served as the primary outcome.After that,the data were statistically analyzed using SPSS software.Results:The trial enrolled 41 patients(32 men and 9 women)who met the inclusion criteria.Among them,25 patients received decompressive decompressive craniectomy,and 16 patients received basal cisternostomy.Three days postoperative intracranial pressure levels were 10.07±2.94 mmHg and 17.15±14.65 mmHg(p=0.013),respectively.The 6 months following discharge Glasgow outcome scale extended of patients was 4.73±2.28 and 3.14±2.15(p=0.027),respectively.Conclusion:Our study reveals that basal cisternostomy in patients with surgically treated severe TBI has demonstrated significant efficacy in reducing intracranial pressure as well as patient prognosis follow-up and avoids removal of the bone flap.The efficacy of cisternostomy has to be studied in larger,multiclinical center randomized trials.展开更多
In subarachnoid hemorrhage following traumatic brain injury (TBI), the high intracisternal pressure drives the cerebrospinal fluid into the brain parenchyma, causing cerebral edema. Basal cisternostomy involves openin...In subarachnoid hemorrhage following traumatic brain injury (TBI), the high intracisternal pressure drives the cerebrospinal fluid into the brain parenchyma, causing cerebral edema. Basal cisternostomy involves opening the basal cisterns to atmospheric pressure and draining cerebrospinal fluid in an attempt to reverse the edema. We describe a case of basal cisternostomy combined with decompressive craniectomy. A 35-year-old man with severe TBI following a road vehicle accident presented with acute subdural hematoma, Glasgow coma scale score of 6, fixed pupils and no corneal response. Opening of the basal cisterns and placement of a temporary cisternal drain led to immediate relaxation of the brain. The patient had a Glasgow coma scale score of 15 on postoperative day 6 and was discharged on day 10. We think basal cisternostomy is a feasible and effective procedure that should be considered in the management of TBI.展开更多
文摘Introduction: Acute post traumatic subdural hematoma is a clinical condition with increased morbidity and mortality despite the developments in neurosurgery and urgent intervention is required to have best clinical outcome. We will evaluate hinged craniotomy technique in terms of offering adequate brain decompression plus avoiding removal of bone flap which requires second replacement surgery in comparison to cisternostomy effect. Material and Methods: A prospective study was conducted over 30 patients with traumatic acute subdural hematoma presented to neurotrauma unit in Cairo University hospitals from January 2017 to February 2018, operated by hinged craniotomy plus evacuation of hematoma and duroplasty. We avoid rapping the head with elastic bandage post-operative. Generous subcutaneous dissection (5 - 7 cm) all around skin flap was done routinely. Effect of brain decompression was evaluated by measuring the level of brain in relation to skull in post-operative computerized topography. Results: Twenty-one patients operated with initial GCS less than eight. Ten cases (33%) show that cortical surface in relation to skull bone was at inner table, nine cases (30%) at diploid layer and two cases (6.7%) at outer table in post-operative CT brain. Twenty patients died (66.7%);eight patients (26.6%) became fully conscious and two patients (6.7%) had vegetative outcome. No re-operation was done in any of our patients. Conclusion: Hinged craniotomy may be a safe and effective alternative technique with comparable results to cisternotomy in cases of traumatic brain injury that require decompression to avoid second surgery, especially in centres lacking cisternostomy experience. Although gaining cisternostomy experience may help in other indications, future prospective studies with larger number are required.
基金supported by Shanxi Provincial Department of Science and Technology[grant number 202203021221241].
文摘Purpose:Traumatic brain injury(TBI)is a significant public health issue that impacts individuals all over the world and is one of the main causes of mortality and morbidity.Decompressive craniectomy is the usual course of treatment.Basal cisternostomy has been shown to be highly effective as an alternative procedure to decompressive craniectomy.Methods:We conducted a retrospective cohort of patients who received surgery for severe TBI between January 2019 and March 2023.Inclusion criterias were patients between the ages of 18 and 70 years who met the diagnostic criteria for severe TBI at first presentation and who underwent surgical intervention.The exclusion criteria were patients who have severe multiple injuries at the time of admission;preoperative intracranial pressure>60 mmHg;cognitive impairment before the onset of the disease;hematologic disorders;or impaired functioning of the heart,liver,kidneys,or other visceral organs.Depending on the surgical approach,the patients were categorized into decompressive craniectomy group as well as basal cisternostomy group.General data and postoperative indicators,including Glasgow coma scale,intracranial pressure,etc.,were recorded for both groups of patients.Among them,the Glasgow outcome scale extended assessment at 6 months served as the primary outcome.After that,the data were statistically analyzed using SPSS software.Results:The trial enrolled 41 patients(32 men and 9 women)who met the inclusion criteria.Among them,25 patients received decompressive decompressive craniectomy,and 16 patients received basal cisternostomy.Three days postoperative intracranial pressure levels were 10.07±2.94 mmHg and 17.15±14.65 mmHg(p=0.013),respectively.The 6 months following discharge Glasgow outcome scale extended of patients was 4.73±2.28 and 3.14±2.15(p=0.027),respectively.Conclusion:Our study reveals that basal cisternostomy in patients with surgically treated severe TBI has demonstrated significant efficacy in reducing intracranial pressure as well as patient prognosis follow-up and avoids removal of the bone flap.The efficacy of cisternostomy has to be studied in larger,multiclinical center randomized trials.
文摘In subarachnoid hemorrhage following traumatic brain injury (TBI), the high intracisternal pressure drives the cerebrospinal fluid into the brain parenchyma, causing cerebral edema. Basal cisternostomy involves opening the basal cisterns to atmospheric pressure and draining cerebrospinal fluid in an attempt to reverse the edema. We describe a case of basal cisternostomy combined with decompressive craniectomy. A 35-year-old man with severe TBI following a road vehicle accident presented with acute subdural hematoma, Glasgow coma scale score of 6, fixed pupils and no corneal response. Opening of the basal cisterns and placement of a temporary cisternal drain led to immediate relaxation of the brain. The patient had a Glasgow coma scale score of 15 on postoperative day 6 and was discharged on day 10. We think basal cisternostomy is a feasible and effective procedure that should be considered in the management of TBI.
