去骨瓣减压术后脑室扩大治疗策略的研究

doi:10.19854/j.cnki.1008-2425.2026.03.0006

摘要/Abstract

摘要： 目的探讨去骨瓣减压术后脑室系统形态改变及其相关治疗。方法回顾分析2019年5月-2025年4月我科治疗的去骨瓣减压术并二期完成颅骨修补术患者216例临床资料:①对其修补术前脑室形态进行测量分析,以第三脑室宽度、侧脑室前角之间距离为两参数,进行脑室系统形态分析;②对去骨瓣减压术后的后续不同治疗措施及继发脑室扩大发生率进行总结;③对继发脑室扩大患者采取单纯修补手术、修补+分流同期手术、修补+Ommaya囊植入术等手术方式进行治疗。结果 ①216例患者的修补术前三脑室宽度、侧脑室前角宽度为4.75±1.80 mm、38.38±7.87 mm,与正常人群均值参数4 mm、 35 mm比较,P＜0.05,有统计学意义;②本组病例中去骨瓣减压术后脑室系统无改变149例,如期行颅骨修补术,继发脑室扩大67例,发生率为31.02%;③67例脑室扩大患者,其中51例患者只行颅骨修补术(8例行修补+OMMAYA囊植入术后评估,不需进一步分流手术),16例行颅骨修补+脑室腹腔分流术(8例分流修补同期手术,8例OMMAYA囊植入+修补手术后评估进一步分流)。出院门诊3月随访,51例只修补患者病情好转稳定,16例脑积水分流手术患者,15例临床症状得到改善,1例轻微加重。结论去骨瓣减压术后脑室系统形态改变比较常见,在临床上正确认识,综合评估,正确决策,可精准实施手术,可改善患者预后。

关键词: 去骨瓣减压术, 脑室形态改变, 脑积水

Abstract: Objective To explore the morphological changes of the ventricular system after decompressive craniectomy and related treatments. Methods A retrospective analysis was conducted on the clinical data of 216 patients who underwent decompressive craniectomy and completed second-stage cranioplasty in our department from May 2019 to April 2025.① The morphology of the ventricles before the cranioplasty was measured and analyzed.The width of the third ventricle and the distance between the anterior angles of the lateral ventricles were taken as two parameters for the morphological analysis of the ventricular system.② Summarize the subsequent different treatment measures and the incidence of secondary ventricular enlargement after decompressive craniectomy.③For patients with secondary ventricular enlargement,treatment methods such as simple cranioplasty,concurrent cranioplasty and shunt surgery,and cranioplasty + Ommaya capsule implantation are adopted for treatment. Results ① The width of the third ventricle and the anterior angle of the lateral ventricle before repair in 216 patients were 4.75±1.80mm and38.38±7.87mm,Compared with the mean parameters of 4mm and 35mm in the normal population,P＜0.05,it was statistically significant.②Among this group of cases,149 cases had no changes in the ventricular system after decompressive craniectomy,and 67 cases developed secondary ventricular enlargement,with an incidence rate of 31.02%.③Among the 67 patients with ventricular enlargement,51 patients underwent cranioplasty,and 16 patients underwent cranioplasty + ventriculoperitoneal shunt.During the follow-up,the conditions of 51 patients who only underwent cranioplasty improved and stabilized.Among the 16 patients who underwent shunt surgery,the clinical symptoms of 15 patients improved,and 1 patient had a slight aggravation. Conclusion Morphological changes in the ventricular system after decompressive craniectomy are relatively common.A proper clinical understanding,comprehensive assessment,and accurate decision-making can enable precise surgical intervention and improve patient outcomes.

Key words: Decompressive craniectomy, Ventricular morphological changes, Hydrocephalus

中图分类号:

R651

张宏兵, 苏宝艳, 刘帅, 张荣军, 马德. 去骨瓣减压术后脑室扩大治疗策略的研究[J]. 立体定向和功能性神经外科杂志, 2026, 39(3): 168-172.

Zhang Hongbing, Su Baoyan, Liu Shuai, Zhang Rongjun, Ma De. Study on treatment strategies for ventriculomegaly after decompressive craniectomy[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2026, 39(3): 168-172.

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