PDF(Pubmed)
Abstract：
Traumatic brain injuries (TBIs) still put a high burden on public health worldwide. Medical and surgical treatment strategies are continuously being studied, but the role and indications of primary decompressive craniectomy (DC) remain controversial. In medically refractory intracranial hypertension after severe traumatic brain injury, secondary decompressive craniectomy is a last resort treatment option to control intracranial pressure (ICP). Randomized controlled studies have been extensively performed on secondary decompressive craniectomy and its role in the management of severe traumatic brain injuries. Indications, prognostic factors, and long-term outcomes in primary decompressive craniectomy during the evacuation of an epidural, subdural, or intracerebral hematoma in the acute phase are still a matter of ongoing research and controversy to this day. Prospective trials have been designed, but the results are yet to be published. In isolated epidural hematoma without underlying brain injury, osteoplastic craniotomy is likely to be sufficient. In acute subdural hematoma (ASDH) with relevant brain swelling and preoperative CT signs such as effaced cisterns, overly proportional midline-shift compared to a relatively small acute subdural hematoma, and accompanying brain contusions as well as pupillary abnormalities, intraventricular hemorrhage, and coagulation disorder, primary decompressive craniectomy is more likely to be of benefit for patients with traumatic brain injury. The role of intracranial pressure monitoring after primary decompressive craniectomy is recommended, but prospective trials are pending. More refined guidelines and hopefully class I evidence will be established with the ongoing trials: randomized evaluation of surgery with craniectomy for patients undergoing evacuation of acute subdural hematoma (RESCUE-ASDH), prospective randomized evaluation of decompressive ipsilateral craniectomy for traumatic acute epidural hematoma (PREDICT-AEDH), and pragmatic explanatory continuum indicator summary (PRECIS).
摘要：
创伤性脑损伤（TBI）仍然给全球公共卫生带来沉重负担。医学和外科治疗策略不断被研究,但原发性去骨瓣减压术(DC)的作用和适应症仍存在争议.在严重创伤性脑损伤后的医学难治性颅内高压中，二次去骨瓣减压术是控制颅内压(ICP)的最后选择.已经对二次去骨瓣减压术及其在严重创伤性脑损伤管理中的作用进行了广泛的随机对照研究。指示,预后因素，和长期的结果在原发性去骨瓣减压术在硬膜外撤离，硬膜下,或脑内血肿在急性期仍然是一个正在进行的研究和争议的问题。已经设计了前瞻性试验，但结果尚未公布。在没有潜在脑损伤的孤立性硬膜外血肿中，开颅手术可能就足够了。在急性硬膜下血肿（ASDH）中，伴有相关脑肿胀和术前CT征象，如出血池，与相对较小的急性硬膜下血肿相比，过成比例的中线移位，以及伴随的脑挫伤和瞳孔异常,脑室内出血,和凝血障碍，原发性去骨瓣减压术更可能对创伤性脑损伤患者有益。推荐原发性去骨瓣减压术后颅内压监测的作用,但未来的审判仍在等待中.正在进行的试验将建立更完善的指南和I类证据：随机评估急性硬膜下血肿（RESCUE-ASDH）患者的颅骨切除术手术，同侧去骨瓣减压术治疗外伤性急性硬膜外血肿的前瞻性随机评价(PREDICT-AEDH),和务实的解释性连续体指标摘要(PRECIS)。
