儿童减压颅骨切除术:一家三级医疗中心的适应症和疗效。

IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY Child's Nervous System Pub Date : 2024-11-01 Epub Date: 2024-07-01 DOI:10.1007/s00381-024-06513-6
Subhas K Konar, Y S Dinesh, Dhaval Shukla, Mohammed Nadeem, Nishanth Sadashiva, Lingaraju T S, Harsh Deora, Gyani Jail Singh, Nagesh C Shanbhag
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引用次数: 0

摘要

导言:减压开颅术(DC)是治疗颅内高压的一种抢救疗法。颅骨减压术的适应症多种多样:方法:回顾性分析小于或等于 18 岁儿童的临床细节、影像学、手术结果和随访数据,以了解过去 5 年中接受颅骨减压术的儿童的更多信息:研究期间,共有 128 名儿童接受了直肠指诊。结果:在研究期间,共有 128 名儿童接受了直流电手术,其中外伤病例 66 例,非外伤病例 62 例。直流电手术的常见适应症是单纯急性硬膜下血肿 33 例(50%),其次是外伤组的挫伤 10 例(15%),非外伤组的动脉梗塞 20 例(32%)和脑静脉血栓 17 例(27%)。114例(89%)进行了半颅骨切除术,7例(5.4%)进行了双额叶颅骨切除术。非外伤病例的中位随访时间为 7 个月,外伤病例为 6 个月。在非创伤组中,GCS小于8分、运动评分小于3分、瞳孔不对称、低血压和基底蝶窦外翻是导致不良预后的相关因素。在回归分析中,只有运动评分低于 3 分与非创伤组相关。在单变量分析中,年龄小于 10 岁、GCS 小于 8 分、运动评分小于 3 分和术前梗死是预测因素,而在回归分析中,只有 GCS 小于 8 分是创伤组不利因素的预测因素:结论:直流电手术是一种挽救生命的手术。结论:直流电手术是一种挽救生命的手术,与创伤病例相比,非创伤病例的不良后果略高。然而,创伤病例的死亡率很高。
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Decompressive craniectomy in children: indications and outcome from a tertiary centre.

Introduction: The role of decompressive craniectomy (DC) is as a rescue therapy for the treatment of intracranial hypertension. The indications for the DC are variable.

Methods: The clinical details, imaging, operative findings and follow-up data of children less than or equal to 18 years of age were reviewed for more information on the children who underwent DC in the last 5 years.

Results: During the study period, a total of 128 children underwent DC. The trauma cases were 66, and the non-trauma cases were 62. The common indication for DC was pure acute subdural hematoma 33 (50%), followed by contusion 10 (15%) in the trauma group, and in non-trauma, arterial infarction in 20 (32%) and cerebral venous thrombosis in 17 (27%). Hemicraniectomy was done in 114 (89%), and bifrontal craniectomy was done in 7 (5.4%) cases. The median duration follow-up was 7 months in non-trauma and 6 months in trauma. GCS was less than 8, the motor score was less than 3, and pupillary asymmetry, hypotension and basal cistern effacement were factors related to an unfavourable outcome in the non-trauma group. In regression analysis, only a motor score of less than three was associated with the non-trauma group. Age less than 10 years, GCS less than 8, motor score less than three and preoperative infarction were the predictive factors in univariate analysis, and only GCS less than 8 was the predictive factor for unfavourable factors in regression analysis in the trauma group.

Conclusion: The DC is performed as a lifesaving procedure. The unfavourable outcome is slightly higher in non-trauma cases compared to trauma cases. However, the mortality rate is high in trauma cases.

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来源期刊
Child's Nervous System
Child's Nervous System 医学-临床神经学
CiteScore
3.00
自引率
7.10%
发文量
322
审稿时长
3 months
期刊介绍: The journal has been expanded to encompass all aspects of pediatric neurosciences concerning the developmental and acquired abnormalities of the nervous system and its coverings, functional disorders, epilepsy, spasticity, basic and clinical neuro-oncology, rehabilitation and trauma. Global pediatric neurosurgery is an additional field of interest that will be considered for publication in the journal.
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