Objective:To explore the clinical efficacy of controlled decompression in the treatment of severe traumatic brain injury (sTBI).Methods:Thirty five patients with sTBI treated by applying controlled decompression surgery from September 2018 to September 2021 in Neurosurgery Department of Haikou Affiliated Hospital of Central South University Xiangya School of Medicine were enrolled into controlled decompression group, another 35 patients with sTBI treated by routine conventional decompression surgery from January 2015 to January 2018 were enrolled into conventional decompression group. The clinical data, complication, length of hospital stay, hospital costs and follow-up results of all cases were analyzed.Results:The surgical time of patients in the controlled decompression group was longer than that in the conventional decompression group, and the proportion of malignant encephalocele was significantly lower than that in the conventional decompression group, with statistical significance (P>0.05). The incidence, hospitalization time, and cost of postoperative complications (hydrocephalus and encephalocele) in the controlled decompression group were significantly lower than those in the conventional decompression group, and the differences were statistically significant (P>0.05). Following up for 6 months, 27 patients in the controlled decompression group achieved good results, 3 patients had severe disability, 3 patients had vegetative survival status, and 2 patients died of postoperative diffuse brain swelling. Among the 35 patients patients in the conventional decompression group, 18 were effective, 8 were severely disabled, 4 were in vegetative state, and 5 died. There was a statistically significant difference in prognosis between the two groups (P<0.05).Conclusion:Controlled decompression has a good effective in the treatment of patients with sTBI and could improve the prognosis of some patients.

Objective:To study the roles of resveratrol in reducing neuroinflammation and improving neurobehavioral functions after germinal matrix hemorrhage (GMH) in neonatal rat model.Methods:GMH model was established intraparenchymally injecting bacterial collagenase in 7-day-old SD rats. 108 rats were randomly assigned into 18 groups (6 in each group), including 4 sham groups, GMH (12 h, 24 h, 72 h, 7 d) groups, 3 GMH+vehicle (dimethylsulfoxide, DMSO) groups, 5 GMH+resveratrol (10 mg/kg, 100 mg/kg, 1 000 mg/kg) groups and 2 GMH+resveratrol+EX527 (SIRT1 inhibitor) groups. Negative geotaxis and righting reflex tests were used to evaluate the short-term neurobehavior. Water maze, foot fault and Rotor-Rod tests were used to assess the long-term neurobehavior. Immunofluorescence was used to quantify the IL-1β and MPO positive cells (inflammatory markers) in peri-hematoma area. Western blot was used to evaluate the expression of relevant proteins in the brain.Results:Endogenous sirtuin-1(SIRT1) decreased to the lowest level at 24 h and then increased gradually. Phosphorylated NF-κB increased at 12 h, peaked at 72 h and returned to normal level at 7 d after GMH. Compared with the control group and other doses groups, GMH treated with resveratrol (100 mg/kg) had higher short-term behavioral scores at 48 h and 72 h. Compared with the control group, the resveratrol (100 mg/kg) group also had higher scores in water maze, foot fault and Rotor-Rod tests 22 days later. Immunofluorescence showed less positive IL-1β and MPO cells around hematoma in GMH+resveratrol group than both GMH+vehicle group and GMH+resveratrol+EX527 group. Western blot indicated that IL-1, TNF-α and IL-6 expressions were decreased in GMH+resveratrol group and Ex527 could offset the effects of resveratrol.Conclusions:Resveratrol (optimal dose: 100 mg/kg) can improve the short-term and long-term neurobehavioral functions of neonatal GMH rats. It can reduce GMH cells with positive inflammatory markers around the hematoma, possibly via inhibition of the SIRT1/NF-κB pathway. Resveratrol may be promising for the treatment of GMH patients.

目的 探讨脑CT灌注成像在早期重型颅脑损伤患者中的应用.方法 收集该院外伤致重型颅脑损伤患者106例(观察组)以及同期轻型脑外伤60例(对照组),均于伤后24 h内进行头颅256排CT灌注成像检查,并比较两组的脑血流灌注率(CBF)、脑血容量(CBV)和平均通过时间(MTT)及3个月后的预后情况等.结果 观察组伤后24 h内脑基底节区、脑干、额叶、顶叶CBF低于对照组,MTT高于对照组,差异均有统计学意义(P＜0.05).基底节、脑干区、额叶、顶叶区CBF与格拉斯哥预后量表(GOS)评分呈正相关(rs=0.902,rs=0.891,rs=0.859,rs=0.786).基底节丘脑区CBV与GOS评分有关.结论 重型颅脑损伤患者早期的CBF值下降,MTT值延长,且CBF值与预后呈正相关,全脑CT灌注成像对早期判断重型颅脑损伤预后有一定临床应用价值.

目的 探讨帽状腱膜下引流治疗慢性硬脑膜下血肿(CSDH)的有效性及安全性.方法 选取2015年1月—2019年12月中南大学湘雅医学院附属海口医院收治的82例帽状腱膜(实验组)和98例硬脑膜下(对照组)引流的CSDH患者,分析其术后并发症发生率、随访期内血肿复发、预后及硬脑膜下血肿/积液情况.结果 实验组与对照组患者术前、拔管前及6个月复查血肿/积液厚度比较:①两组血肿/积液厚度有差异(F=1.684,P=0.000);②实验组与对照组血肿/积液厚度无差异(F=0.277,P=0.758);③两组的血肿/积液厚度变化趋势无差异(F=2.164,P=0.142).实验组手术时间短于对照组(P<0.05).两组患者二次手术、术后感染、癫痫发作、死亡率、随访期内复发率及6个月来院复查MRS评分情况比较,差异无统计学意义(P>0.05).实验组皮层损伤率低于对照组(P>0.05).结论 帽状腱膜与硬脑膜下引流临床疗效相当,且手术时间更短,更简便、安全,具有临床应用潜力.

<正>CT灌注成像(computed tomography perfusion imaging,CTPI)是一种功能成像的方法。1991年,Miles等[1]学者首先提出CTPI的概念,利用CT扫描和计算机图像处理系统,既能显示形态学变化,又能反应功能改变。随着多层螺旋CT的应用与数学模型的不断改进,CTPI不断发展和完善,在脑及全身多种组织和器官疾病的研究和临床诊断中都已经用到该项技术。本文就当前CTPI在中枢神经系统疾病诊断中的应用和研究进展综述如下。

目的 探讨256层螺旋CT血管造影(256-CTA)在蛛网膜下腔出血(SAH)诊断中的应用价值.方法 对2010年12月到2011年12月54例SAH患者行MSCTA检查与数字减影血管造影(DSA)检查,分析256-CTA与DSA检查结果并相互比较.结果 54例患者中256-CTA检出动脉瘤42例,静脉窦血栓2例,动静脉畸形6例,阴性4例；DSA结果显示动脉瘤44例,动静脉畸形5例,静脉窦血栓2例,阴性3例,其中经临床与DSA证实1例CTA假阳性.结论 256-CTA是一种无创、快速、便捷的影像学检查方法,可清晰显示血管的空间立体结构与周边关系,对治疗方法的选择和难度的评估有利,且对SAH的病因诊断具有重大意义.

Objective To evaluate the methods and effects of microsurgical treatment for traumatic subdural hygromas with microsurgery.Methods Failed in conservational treatments,22 cases of traumatic subdural hygromas were treated by sylvian arachnoid ostomy and subdural external drainage via pterional keyhole approach.The surgical details were described,and the clinical data were retrospectively reviewed as well as the surgical results.Results No complications occurred in our serial.One month after surgery,subdural hygromas disappeared totally or subtotally in 21 cases,whereas one patient was unchanged and it was necessary to perform a subdural to peritoneal shunt.Three months after surgery,subdural hygromas disappeared totally or subtotally in all patients.Conclusions Sylvian arachnoid ostomy and subdural external drainage via pterional keyhole approach is a safe and effective way for traumatic subdural hygromas.