Application of continuous intracranial pressure monitoring after standard decompression and microhematoma removal in patients with severe craniocerebral injury and cerebral hemorrhage complicated with cerebral hernia
WANG Zhong ZHANG Ruijian HAN Zhitong WANG Junqing WU Rile ZHANG Xiaojun LIU Baiyu YANG Weiran
Department of Neurosurgery, Inner Mongolia People′s Hospital, Inner Mongolia Autonomous Region, Hohhot 010017, China
Abstract：Objective To analyze the clinical value of continuous intracranial pressure monitoring, standard decompressive craniectomy with mega-bone flap and microscopic hematoma evacuation in the treatment of severe craniocerebral injury and severe massive cerebral hemorrhage with cerebral hernia. Methods From May 2016 to May 2019, 116 patients with severe craniocerebral injury and massive hypertensive intracerebral hemorrhage with cerebral hernia underwent standard decompressive craniectomy with mega-bone flap, microscopic hematoma evacuation and intraoperative implantation of intracranial pressure monitoring probe, in Department of Neurosurgery, Inner Mongolian People′s Hospital were selected. The intracranial pressure monitoring changes, clinical significance and prognosis (Glasgow outcome scale score) at 6 months after treatment were analyzed. Results There were 116 patients were monitored by continuous dynamic intracranial pressure monitoring. Among them, 19 patients had an intracranial pressure over 40 mmHg (1 mmHg=0.133 kPa), 8 patients suffered from re-bleeding after operation and underwent additional hematoma evacuation, and 3 patients died, the other 8 patients recovered with medical management under intracranial pressure monitoring; the other 97 patients experienced a transient intracranial hypertension which was lower than 40 mmHg during 2-7 days after surgery. All of their intracranial pressure decreased after treatment and fluctuated within a narrow range. The Glasgow outcome scale score of 116 patients showed that, 67 cases with grade 5, 34 cases with grade 4, 9 cases with grade 3, 3 cases with grade 2 and 3 cases with grade 1. Conclusion Microscopic hematoma evacuation and standard decompressive craniectomy with mega-bone flap could remove hematoma quickly and alleviate intracranial hypertension in patients with severe craniocerebral injury and massive cerebral hemorrhage associated with brain herniation. Intracranial pressure monitoring probe implantation during surgery and continuous intracranial pressure monitoring after operation could timely detect intracranial pressure changes, guide a reasonable clinical use of dehydration drugs and discover intracranial complications early, which is of practical importance to improve the prognosis of patients with severe traumatic brain injury and massive cerebral hemorrhage combined with cerebral hernia after standard decompressive craniectomy with mega-bone flap.
王忠 张瑞剑 韩志桐 王俊青 吴日乐 张晓军 刘白雨 杨薇然. 持续颅内压监测在重度颅脑损伤及脑出血合并脑疝患者标准大骨瓣减压术及显微血肿清除术后的应用[J]. 中国医药导报, 2020, 17(5): 75-78,82.
WANG Zhong ZHANG Ruijian HAN Zhitong WANG Junqing WU Rile ZHANG Xiaojun LIU Baiyu YANG Weiran. Application of continuous intracranial pressure monitoring after standard decompression and microhematoma removal in patients with severe craniocerebral injury and cerebral hemorrhage complicated with cerebral hernia. 中国医药导报, 2020, 17(5): 75-78,82.
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2020, Vol. 17 
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