Rationale for surgical treatment of patients with traumatic brain injury on the background of hypertensive syndrome
Science Articles / / May 14, 2016
Samara State Medical University
Central City Hospital, Novokuybyshevsk
studies of operated patients with intracranial hematoma showed that one of the main causes of deaths are complications in the early postoperative period, relapsebruising, swelling and brain swelling.
Among the many complications of early postoperative period deserve special attention those situations that require immediate reoperation, This primarily refers to the repeated intracranial hemorrhage (recurrent bruising, formation of hematoma in operative surgery), a progressive edema and swelling, causes an increase inintracranial pressure, and compression of dislocation of the brain, especially on the background of hypertensive syndrome.
Materials and Methods. In 2002-2003, Novokuibyshevsk central city hospital delivered and operated on 12 patients with traumatic brain injury on the background of hypertensive syndrome with hemorrhage into the lateral ventricles.Of the 12 injured 7 men and 5 women, aged from 26
Two victims made resection of bone 9x10 cm., With a cross-sectional view of the dura mater, was removed from the subdural space of about 5-6 ml.CSF with blood.Brain purple - red, swollen, sticks out into the wound.With the puncture needle emptied the left ventricle.Removed from its cavity about 20 ml.CSF in the blood pressure ratio 50x50.Cerebral edema slept.Spend drainage subdural space, the wound sutured in layers.Patients after surgery were on mechanical ventilation in the ICU environment, where they spent the dehydration symptomatic anti-inflammatory and antibacterial restorative therapy.
drainage of a subdural space is removed the next day.Held daily dressing of surgical wounds.
Despite intensive therapy, both patients died na 6-7 days after surgery.At autopsy the brain dramatically swollen with groove herniation of the medulla oblongata at the foramen magnum, the left lateral ventricle was a large number of CSF with blood.
Based on the results, two patients with a similar injury against the background of hypertensive syndrome performed resection of bone temporo-parietal region 9x10sm., Cross-sectional view of the dura mater, the removal of the subdural space of CSF with blood.Brain purplish-red, swollen, bulging into the wound.Needle puncture of the left lateral ventricle removed about 20 ml.CSF in the blood pressure ratio 50x50.Cerebral edema slept.Then the cavity of hematoma inserted conductor.After removal of the puncture needle from the left lateral ventricle through a conductor it introduced prefabricated PVC drainage tube with a lumen diameter of 4 mm.A drainage tube into the left lateral ventricle "washed out with a solution furatsilina. Drain pipe in the subdural space is left for a day, the wound in layers sutured to the drainage pipe stapled to the skin. The patients were on mechanical ventilation in the conditions of the intensive care unit, where a conservative complex therapy.
left lateral ventricle through the drain tube with a gap 6 hours for 5 days washed in freshly prepared with a special solution (100 ml. of the standard solution furatsilina + 2 ml. heparin + 2000000 ketatsefa).
continued mechanical ventilation, intensive care and washing the left sideventricle every 6 hours. At 5 days after surgery in patients showing signs of spontaneous breathing and glimpses of consciousness. upon further washing was a decrease, and then the complete disappearance of the blood discharge. With this in mind, the drainage of the lateral ventricle is removed. On the 5th day after the operation forimprove rehabilitation tracheobronchial tree, given the copious sputum and unconscious, both patients underwent surgery the lower middle tracheotomy.
7-8 hours in patients with consciousness, translated into spontaneous breathing.Both patients in place drainage tubes formed cerebrospinal fluid fistula, which closed after a week of treatment themselves.In the future course of symptomatic patients with activated regenerative therapy.Tracheotomy tube removed, the fistula healed in a satisfactory condition, patients discharged.Within three months after the surgery, patients were inpatient treatment in a neurological department, and then outpatient treatment under the supervision of a neurologist and neurosurgeon.After three months, patients underwent plastic surgery of the skull vault defect protokrilovym implant.One of the patients additionally removed a small liquor cyst.
Conclusions. On the basis of studies of patients with traumatic brain injury on the background of hypertensive syndrome, it can be concluded that the drainage of lateral ventricle hemorrhage, followed by washing the ventricular cavities every 6 hours for 4-5 days with a special solution, results are superior to the classical method of treatmentand enables a favorable prognosis, not only on health but also life.