Indications for surgical ablation of intracranial hematomas
• Clinical signs of compression of the brain after at least one of the criteria: focal, general cerebral or dislocation symptoms.
• The volume of epidural or intracerebral hematoma (after the findings of CT, MRI) is over 50 ml for supratentorial and over 20 ml for subtentorial ones.
• The thickness of epidural hematoma is more than 1,5 cm regardless of a clinical phase including that in the lucid interval.
• A repeated disorder or worsening of consciousness in the presence of lucid interval.
• The presence of at least one sign after CT (MRI): lateral displacement of midline structures of over 5 mm, deformation of basal cisterns, rough compression of the lateral ventricle with dislocation, counterlateral hydrocephaly, regardless of the sizes and localization of hematoma
• Hematomas of the posterior cranial fossa of a small volume (< 20 ml), if they result in occlusive hydrocephaly.
In removing of acute hematomas, the surgical tactics consists of the following measures carry out trepanation of the skull, removing of hematoma, arrest of bleeding. If before the operation the location and size of hematoma were determined by CT or MRI, implementation of osteoplastic trepanation is preferable. In the absence of such information, implementation of a linear incision of the skin and resection trepanation is expedient.
In subacute and chronic hematomas, as well as subdural hydromas, the most adequate surgical intervention is removing of these formations by applying bun- holes. Lately, one of alternative methods of surgical treatment of some intracranial hematomas is their endoscopic ablation.
Methods of bleeding arrest depend on the nature of bleeding and the type of the damaged vessels: meningeal and cerebral vessels most frequently coagulate, the defect of the sinus is closed by its occlusion with a hemostatic sponge, suture ligation, plastics, and in some cases bandaging on the extent. In bleeding from diploic veins, the edges of bone splinters are spread with surgical wax.
In depressed fractures, virtually in all cases, if the splinters of the depressed fracture penetrate no less than the thickness of the bone, surgical intervention is, even if no neurological symptomatology arises.
Indications for surgical treatment of contusions of the brain:
• Apparent clinical signs of dislocation of the brain.
• CT(MRI)-signs of lateral (displacement of midline structures by more than 5 mm) and axial (deformation of basal cisterns) dislocation of the brain.
• Signs of growing drug-resistant intracranial hypertension (an increase of the intracranial pressure by more than 20-25 mm Hg, indexes of the osmolarity of the blood plasma below 280 mmol/l, or over 320 mmol/l).
In contusion, they carry out palliative (ventriculopuncture with setting of long- term external ventricular drainage, setting of long-term external lumbar drainage, liquoroshunting operations, decompress trepanation of the skull) and radical operations (osteoplastic trepanation, aspiration and washing of cerebral detritus).
Date: 2015-01-02; view: 798