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首页> 外文期刊>Surgical Neurology International >Aggressive internal and external decompression as a life-saving surgery in a deeply comatose patient with fixed dilated pupils after severe traumatic brain injury: A case report
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Aggressive internal and external decompression as a life-saving surgery in a deeply comatose patient with fixed dilated pupils after severe traumatic brain injury: A case report

机译：在严重创伤脑损伤后，具有固定扩张的瞳孔的侵略性内和外部减压作为一种救命手术，在严重的创伤脑损伤后具有固定的扩张瞳孔：案例报告

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Background: To maximize control of the intracranial pressure in deeply comatose patients with malignant cerebral swelling, combination of the surgical techniques for internal and external brain decompression may be reasonable, as demonstrated in the presented case. Case Description: A 55-year-old man was admitted with Glasgow Coma Scale (GCS) score 4, maximally dilated pupils, and absence of the pupillary light and vestibulo-ocular reflexes. Head CT revealed massive acute subdural hematoma, prominent brain shift with subfalcine and transtentorial herniation, and diffuse subarachnoid hemorrhage. Large size decompressive craniectomy and evacuation of subdural hematoma were done, however, prominent swelling of the brain and its protrusion through the bone defect remained. Therefore, extensive temporal lobectomy and removal of the bulk of temporal muscle were additionally attained followed by lax duraplasty. Gradual recovery of the patient was noted from the 1supst/sup postoperative day, and on the 70supth/sup day, his GCS score was 4T4. Three months later, his condition corresponded to the Glasgow Outcome Scale score 3 (severe disability). Conclusion: Aggressive internal and external decompression with combination of large size craniectomy, extensive temporal lobectomy, removal of the bulk of temporal muscle, and lax duraplasty should be considered as possible life-saving option in cases of neurosurgical emergencies with malignant cerebral swelling.
机译：背景：为了最大限度地控制对恶性脑肿胀的深度昏迷患者的颅内压力，外部和外部脑减压的手术技术的组合可能是合理的，如呈现的情况下所示。案例描述：一名55岁的男子被Glasgow Coma Scale（GCS）得分4，最大扩张的瞳孔，并且缺乏瞳孔光和前院反射。头CT揭示了大规模的急性软骨血肿，突出的脑与脱鼠和抗静脉疝转移，并弥漫性蛛网膜下腔出血。然而，通过骨缺损突出的大小减压颅骨切除术和软骨血肿的疏散，突出的肿胀及其突起仍然存在。因此，另外达到了广泛的颞型肺切除术和去除大部分时间肌肉，然后达到疏松含量。患者逐渐回收术后一天，并在70 th 日，他的gcs得分为4t4。三个月后，他的条件与Glasgow结果规模得分3（严重残疾）相对应。结论：具有大尺寸颅骨切除术的组合，广泛的颞叶，颞肌的侵略性的内部和外部减压，以及LAX杜拉料术应在神经外科急诊发生的情况下作为可能的救生期权认为，恶性脑肿胀。

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