颅内空间体积和压力与颅骨切除表面积和脑疝之间的相关性:基于模型的研究。

IF 1.8 Q3 CLINICAL NEUROLOGY Neurotrauma reports Pub Date : 2024-03-27 eCollection Date: 2024-01-01 DOI:10.1089/neur.2024.0006
Sudip Kumar Sengupta, Rohit Aggarwal, Manish Kumar Singh
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引用次数: 0

摘要

有些人支持减压开颅术(DC)及其各种改良方法,并声称每种方法都能取得合理的临床疗效。脑外伤病例的临床疗效取决于多种因素,这些因素在患者之间差异很大,而且相互影响十分复杂,因此很难将一个病例与另一个病例进行绝对比较。因此,我们认为有必要建立一个标准模型,以便在这一领域进行研究、比较和制定战略。我们设计了一个基于模型的模型,并展示了研究结果,该模型旨在建立颅内空间体积和颅内压(ICP)变化与 DC 期间形成的颅骨切除缺损表面积和脑疝体积之间的相关性。在 128 层计算机断层扫描仪上对一个大致呈半球形的放射性不透明容器进行扫描。不同大小和形状的颅骨切口被标记在模型壁上。随后,将两个由可拉伸材料制成的球形囊放入模型内,固定在三通连接器上,注入水,并连接上传感器。传感器电缆的终端通过信号放大器和处理器模块与显示监视器相连。移除部分模型壁,让部分囊疝出,模拟直流。使用 AW volume share 7® 软件进行体积测量。切除 12.7 × 11.5 厘米的部分腔壁后,腔壁上出现了一个直径为 10 厘米的缺损。35 毫升的容积差导致中线向容积较小的一侧偏移 5 毫米。在测量模型内部两个可拉伸囊的压力时,即使两侧囊中的液体量相等,在不同的记录中也始终存在 1 到 2 毫米汞柱的压力差。在同侧囊壁完整的情况下,在同侧囊壁上产生 35 毫米汞柱的腔内压力,在对侧囊壁上产生 33 毫米汞柱的腔内压力,形成直径为 10 厘米的圆形囊壁缺损,从而导致 48.411 立方厘米的真实体积膨胀。疝气导致两个膀胱的压力降低,同侧膀胱的压力记录为 25 毫米,对侧膀胱的压力记录为 24 毫米。研究结果与其他基于模型的研究结果非常吻合。对所用材料的改进有可能为实时研究颅容量、ICP、开颅手术大小和脑脱垂体积提供一个有效的平台。该模型将有助于术前在经典 DC、铰链开颅术和扩张性开颅术之间选择最适合难治性 ICP 升高病例的技术。
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Correlation Between Volume and Pressure of Intracranial Space With Craniectomy Surface Area and Brain Herniation: A Phantom-Based Study.

There are proponents of decompressive craniectomy (DC) and its various modifications who claim reasonable clinical outcomes for each of them. Clinical outcome in cases of traumatic brain injury, managed conservatively or aided by different surgical techniques, depends on multiple factors, which vary widely among patients and have complex interplay, making it difficult to compare one case with another in absolute terms. This forms the basis of the perceived necessity to have a standard model to study, compare, and strategize in this field. We designed a phantom-based model and present the findings of the study aimed at establishing a correlation of the volume of intracranial space and changes in intracranial pressure (ICP) with surface area of the craniectomy defect created during DC and brain herniation volume. A roughly hemispherical radio-opaque container was scanned on a 128-slice computed tomography scanner. Craniectomies of different sizes and shapes were marked on the walls of the phantom. Two spherical sacs of stretchable materials were subsequently placed inside the phantom, fixed to three-way connectors, filled with water, and connected with transducers. The terminals of the transducer cables were coupled with the display monitor through a signal amplifier and processor module. Parts of the wall of the phantom were removed to let portions of the sac herniate through the defect, simulating a DC. Volume measurements using AW volume share 7® software were done. Resection of a 12.7 × 11.5 cm part of the wall resulted in a 10-cm-diameter defect in the wall. Volume differential of 35 mL created a midline shift of 5 mm to the side with lesser volume. When measuring pressure in two stretchable sacs contained inside the phantom, there always remained a pressure differential ranging from 1 to 2 mm Hg in different recordings, even with sacs on both sides containing an equal volume of fluids. Creating a circular wall defect of 10 cm in diameter with an intracavitary pressure of 35 mm Hg on the ipsilateral sac and 33 mm on the contralateral sac recorded with intact walls, resulted in a true volume expansion of 48.411 cm3. The herniation resulted in a reduction of pressure in both sacs, with the pressure recorded as 25 mm in the ipsilateral sac and 24 mm in the contralateral sac. The findings closely matched those of the other model-based studies. Refinement of the materials used is likely to provide a valid platform to study cranial volume, ICP, craniectomy size, and brain prolapse volume in real time. The model will help in pre-operatively choosing the most appropriate technique between a classical DC, a hinge craniotomy, and an expansive cranioplasty technique in cases of refractory raised ICP.

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