THE EFFECTIVENESS OF ADDITIONAL METHODS OF DECOMPRESSION IN PATIENTS WITH SUPRATENTORIAL DISLOCATION OF THE BRAIN
DOI:
https://doi.org/10.53555/nnmhs.v4i9.607Keywords:
Dislocation of the brain, decompressive craniotomy, microsurgical resection of the temporal lobeAbstract
The aim of the study is to evaluate the effectiveness of additional methods of external and internal decompression in patients with supratentorial dislocation in focal lesions of the cerebral hemispheres.
Materials and methods: A retrospective analysis of 219 cases of supratentorial compression of the brain in patients hospitalized in the Clinic of Neurosurgery of the National Hospital of the Kyrgyz Republic was conducted. In the main group of 143 observations, the assessment of the severity of dislocation syndrome according to our 12-point scale was performed; according to the results of this assessment, after the eradication of the focal lesions, additional methods of external and/or internal decompression were used. The drainage of the lateral ventricles and the one-sided wide infratemporal decompressive craniotomy in severe cases supplemented by the microsurgical resection of the mediobasal parts of the temporal lobe were performed.
Results: The analysis of the study showed an increase in unfavorable outcomes with the growth of the severity of DS. Thus, the gross residual effects found in stage I in 17.4% of the patients, in stage II were already found in 43.0%, and in stage IV - 69.4% of the observations. The group with fatal outcomes was even more demonstrative, which showed a clear increase in the number of deaths of patients as the severity of the dislocation progressed. Among patients with DS in stage I, 19.4% died, while in stage III - 32.1 %, and in stage V (the most severe) – 2 of 3 patients died, making up 66.7% of this group. The total number of deaths in both groups was 51 cases (23.2%); at that a significantly smaller percentage of failures of the treatment (p <0.05) was found in patients of the main group making up 20.2%, compared to 29.0% of the control group.
Conclusion: the findings of the clinical and instrumental examinations of patients in the postoperative period confirm the high effectiveness of methods of additional external and internal decompression, a high percentage of survival of patients in the main group and a decrease in the number of deaths in the treatment compared to the control group.
References
[Blinkov S.M., Smirnov N.A. Displacements and deformations of the brain. Morphology and clinic. - L .: Medicine, 1967. – P.204.
[Dubchev D.I. Dislocation syndrome in an acute period of craniocerebral trauma (clinicopathomorphological study): Diss. ... MD. -Almaty., 2009. – P.97.
[3. Zotov Yu.V., Kondakov E.N., Shchedrenok V.V., Kondratiev A.N. Intracranial decompression of the brain in the surgery of severe craniocerebral trauma. - St. Petersburg: Ed. Russian Neurosurgical Institute named after professor A.L. Polenov, - 1999. – P.142.
[Krylov V.V., Talypov A.E., Puras Yu.V. Efremenko S.V. Secondary Factors of Brain Damage in Craniocerebral Trauma // Russian Medical Journal. - 2009. - No. 3. - P. 23-28.
[Lebedev V.V., Krylov V.V. Dislocation syndrome in acute neurosurgical pathology // Neurosurgery. -2000. – No. 12 - P. 4-11.
[Proskurina Т.S. Acute dislocation syndrome with traumatic brain injury and intracerebral hemorrhages: Diss. ... MD. - Moscow, 1980. – P.161.
[Sirovsky E.B., Paltsev E.I., Manevich A.Z. et al.. The volume-pressure ratio in the craniospinal cavity with supra- and subtentorial pathology. II. Change of local intracerebral pressure in cerebrospinal fluid compression and brain decompression // Issues of Neurosurgery named after N.N. Burdenko. - 1981. - No. 3 - P. 33-39.
[Talypov A.E., Puras Yu.V., Krylov V.V. Methods of trepanation in the surgery of severe craniocerebral trauma / Consilium Medicum. Ad. Surgery. - 2009. - No. 1. - P. 8-12.
[Khominsky B.S. To the pathomorphology of the inclinations into the tentorial hole. Khominsky // Issues of Neurosurgery named after N.N. Burdenko. 1954 - No. 6.-C. 9-17.
[ Basauri L., Fierro J., Rocamora R. Le resection temporal: supapel en el tratamiento del traumatismo encefalo craneano grave. // Neurocirurgia (Santiago). — 1968. — Vol. 26. — № 3. —P. 148-153.
[ Chesnut R.M., Marshall L.F., Klauber M.R. et al. The role of secondary brain injury in determining outcome from severe head injury // J.Trauma. — 1993. — Vol. 34. — P. 216-222.
[ Chibbaro S., Marsella M., Romano A. et al. Combined internal uncusectomy and decompressive craniectomy for the treatment of severe closed head injury: experience with 80 cases // J. Neurosurg. — 2008. — Vol. 108. — Р. 7479.
[ Litofsky N.S., Chin L.S., Tang G. et al. The use of lobectomy in the management of severe closed head trauma
(clinical study) // J. Neurosurg. — 1994. — Vol. 34. — Р. 628-632.
[ Mori K., Ishimaru S., Maeda M. Unco-Parahippocampectomy for direct surgical treatment of downward transtentorial herniation // Acta Neurochir. — 1998. — Vol. 140. — P. 1239-1244.
[ Nussbaum E.S., Wolf A.L., Sebring L., Mirvis S. Complete temporal lobectomy for surgical resuscitation of patients with transtentorial herniation secondary to unilateral hemispheric swelling // J. Neurosurg. — 1991. — Vol. 29. — Р. 62-66.
[ Reid W.L. Cerebral herniation thgross incisura tentorii: a clinical, pathological, and experimental study // Surgery
— 1940. — Vol. 8. — Р. 756-770.
[ Sarabia R., Lobato R.D., Rivas J.J. Cerebral hemisphere swelling in severe head injury patients // Acta Neuroshir.
(Wien). Suppl. — 1988. — Vol. 42. — Р. 40-46.
[ Scoville W.B., Bettis D.B. Unilateral inferior temporal lobectomy with hippocampectomy for relief of incisural
herniation // Acta Neuroshir. (Wien). — 1979. — Vol. 47. № 3-4 — Р. 149-160.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Licensing
Ninety Nine Publication publishes articles under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This licensing allows for any use of the work, provided the original author(s) and source are credited, thereby facilitating the free exchange and use of research for the advancement of knowledge.
Detailed Licensing Terms
Attribution (BY): Users must give appropriate credit, provide a link to the license, and indicate if changes were made. Users may do so in any reasonable manner, but not in any way that suggests the licensor endorses them or their use.
No Additional Restrictions: Users may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
