开颅减压手术治疗出血性颅内静脉窦血栓并发脑疝的疗效分析  

Analysis of therapeutic effect of decompressive craniotomy in the treatment of hemorrhagic intracranial venous sinus thrombosis complicated with cerebral herniation

作　　者：付永鹏 马强 于洮[2] 拉巴索朗 姚博瀚 单永炳 顾卫彬[3] 杨苏乔[4] 曹晓昱[2] Fu Yongpeng;Ma Qiang;Yu Tao;Labasuolang;Yao Bohan;Shan Yongbing;Gu Weibin;Yang Suqiao;Cao Xiaoyu(Department of Neurosurgery,Lhasa People's Hospital,Lhasa 85000,China;Neurosurgery Center,Bejing Tiantan Hospital,Capital Medical University,Bejing 100070,China;Department of Radiology,Bejing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Pulmonary and Critical Care Medicine,Beijing Chao-Yang Hospital,Capital Medical University,Beijing Institute of Respiratory Medicine,Bejing 100020,China)

机构地区：[1]拉萨市人民医院神经外科,拉萨850000 [2]首都医科大学附属北京天坛医院神经外科学中心,北京100070 [3]首都医科大学附属北京天坛医院放射科,北京100070 [4]首都医科大学附属北京朝阳医院呼吸与危重症医学科,北京呼吸疾病研究所,北京100020

出　　处：《中华神经外科杂志》2023年第5期471-475,共5页Chinese Journal of Neurosurgery

基　　金：西藏自治区自然科学基金组团式医学援藏项目[XZ2022ZR-ZY19(Z)]。

摘　　要：目的 探讨开颅减压手术治疗出血性颅内静脉窦血栓并发脑疝的疗效.方法 回顾性分析2019年10月至2022年8月首都医科大学附属北京天坛医院神经外科学中心(5例)和拉萨市人民医院神经外科(2例)行开颅减压手术治疗的7例出血性颅内静脉窦血栓并发脑疝患者的临床资料.术前患者格拉斯哥昏迷评分(GCS)中位数为6分(3~11分).所有患者术前影像学检查均显示颅内静脉窦血栓出血伴脑疝征象,且患者意识障碍进行性加重.患者均行去骨瓣减压手术,5例患者同时行血肿清除术.以术后1周GCS及术后3~6个月改良Rankin量表评分(mRS)评价疗效及预后.结果 7例患者手术均顺利完成.术后1周GCS为3~15分.2例于术后1 d死亡,1例于术后31d死亡.4例生存患者的随访时间为3~36个月.术后患者口服抗凝药物治疗3~12个月.3~6个月复查头颅CT静脉血管成像或磁共振静脉成像未见颅内新发静脉窦血栓形成及出血.至末次随访,预后较好(mRS 1~2分)2例,预后较差(mRS 3分)2例.结论 对于出血性颅内静脉窦血栓并发脑疝的患者,开颅减压手术可在一定程度上改善患者预后,但该病总体预后较差.Objective To investigate the therapeutic effect of decompressive craniotomy in the treatment of hemorrhagic intracranial venous sinus thrombosis complicated with cerebral herniation.Methods A retrospective analysis was conducted on the clinical data of 7 patients of hemorrhagic intracranial venous sinus thrombosis complicated with cerebral hernia who underwent decompressive craniotomy in the Neurosurgery Center of Beijing Tiantan Hospital,Capital Medical University(5 cases)and the Department of Neurosurgery of Lhasa People's Hospital(2 cases)from October 2019 to August 2022.The median Glasgow coma score(CCS)of patients before operation was 6(3-11).Intracranial venous sinus thrombosis complicated with cerebral herniation was confirmed by imaging examination before operation in all patients,and the disturbance of consciousness was progressively aggravated.All patients underwent decompressive craniectomy,and 5 patients underwent simultaneous hematoma evacuation.The therapeutic effect and outcome were evaluated by CCS at 1 week after operation and modified Rankin Scale(mRS)at 3-6 months after operation.Results The operations of 7 patients were all successfully completed.One week after operation,the GCS ranged from 3 to 15.Two cases died 1 day after operation,and 1 case died 31 days after operation.The follow-up period of 4 surviving patients ranged from 3 to 36 months.Postoperatively,the patients were treated with oral anticoagulant drugs for 3 to 12 months,and no new intracranial venous sinus thrombosis or hemorrhage was found in CT venous angiography or magnetic resonance venography after 3 to 6 months.By the last follow-up,2 cases had good outcome(mRS:1-2),and 2 cases had poor outcome(mRS:3).Conclusion For patients with hemorrhagic intracranial venous sinus thrombosis complicated by cerebral herniation,decompressive craniotomy can improve the outcome of patients to a certain extent,but the overall prognosis of the disease seems poor.

关 键 词：窦血栓形成 颅内 颅内出血 减压颅骨切除术 治疗结果 

分 类 号：R651.1[医药卫生—外科学]