重型颅脑损伤去骨瓣减压术后硬脑膜下积液

摘要

目的 探讨重型颅脑损伤患者行去骨瓣减压术后硬脑膜下积液的临床特点及意义.方法 对行去大骨瓣减压术的31例重型颅脑损伤患者,通过动态CT观察硬脑膜下积液的发生、发展及演变过程.结果 硬脑膜下积液通常在去骨瓣减压术后2周内出现,硬脑膜下积液的部位多变,额颞顶部多见.积液不导致患者原有意识恶化或出现新增神经病学症状,且最终均能消退；有明显占位效应的积液在消退时患者常发展为严重脑积水.结论 重型颅脑损伤去骨瓣减压术后硬脑膜下积液的形成是疾病发展过程中的一种代偿机制,针对积液本身不需要特殊治疗；有占位效应的硬脑膜下积液常预示严重脑积水的形成.%Objective To summarize the clinical characteristics and significance of subdural effusion(SDE) in patients with severe brain injury after decompressive craniectomies(DC). Methods The dynamic CT scans were performed to observe the occurance,development and evolution of SDE in 31 patients with severe brain injury after DC. Results SDE usually occurred within 2 weeks after DC. The location was varied with a frequent occurrence in the frontal-temporo-parietal areas. SDE neither worsen patient s consciousness or caused new neurological deficits,and could be absorbed at last. The patients with massive SDE developed hydrocephalus finally. Conclusion SDE is a kind of compensatory mechanism after DC in patients with severe brain injury and does not need to be treated aggressively. SDE with massive occupation signs predicts a development of severe hydrocephalus.