1、附属医院AFFILIATED HOSPITAL OF SOUTHWEST MEDICAL UNIVERSITY附属医院AFFILIATED HOSPITAL OF SOUTHWEST MEDICAL UNIVERSITY发生率发生率脑外伤后脑积水发生率脑外伤后脑积水发生率为为 0.7-2.9%去骨瓣减压术后去骨瓣减压术后脑积水（脑积水（PTH）发生率）发生率 JOURNAL OF NEUROTRAUMA (2011) 10-40%附属医院AFFILIATED HOSPITAL OF SOUTHWEST MEDICAL UNIVERSITY诊断诊断Evans指数指数MRIICP脑室系统扩大脑室系
2、统扩大去骨瓣后去骨瓣后Evans指数还准嘛？指数还准嘛？骨瓣缺失骨瓣缺失 ICP波动？波动？T2间质性水肿？间质性水肿？脑膨出？脑膨出？脑萎缩？脑萎缩？附属医院AFFILIATED HOSPITAL OF SOUTHWEST MEDICAL UNIVERSITY治疗治疗1. 颅骨修补颅骨修补2. 脑积水的治疗脑积水的治疗先补后分流？先分流后补？同时？先补后分流？先分流后补？同时？V-P？ ETV？附属医院AFFILIATED HOSPITAL OF SOUTHWEST MEDICAL UNIVERSITY危险因素危险因素双侧去骨瓣双侧去骨瓣大骨瓣大骨瓣脑室内积血脑室内积血去骨瓣对侧硬膜下积液去
3、骨瓣对侧硬膜下积液颅骨修补时间延迟颅骨修补时间延迟J Korean Neurosurg Soc (2015) 独立危险因素独立危险因素附属医院AFFILIATED HOSPITAL OF SOUTHWEST MEDICAL UNIVERSITY危险因素危险因素只只与骨瓣边缘与骨瓣边缘与中线的距离有关与中线的距离有关骨瓣边缘骨瓣边缘与中线的与中线的距离距离25mm，去骨瓣减压最去骨瓣减压最主要在于减轻颞部压力主要在于减轻颞部压力 尽早修补颅骨，恢复正常解剖尽早修补颅骨，恢复正常解剖 在在颅内压监测下手术颅内压监测下手术，尽量小范围去骨瓣，尽量小范围去骨瓣附属医院AFFILIATED HOSPITAL OF SOUTHWEST MEDICAL UNIVERSITY
