关键词: 对冲性颅脑损伤, 双侧血肿, 颅压监护, 术中超声检查, 开颅手术

Abstract: 【Abstract】〓Objective〓To explore the operation strategy for bilateral intracranial hematoma caused by countercoup craniocerebral injury,in order to improve the prognosis of such patients. Methods〓Clinical data of 97 patients with contrecoup craniocerebral injury operated by the same surgeon in our craniocerebral trauma center from Oct 2011 to Oct 2014 were retrospectively analyzed, the patients were divided into three types according to the CT preoperatively,type I:epidural hematoma was mainly in the injured side (20 cases), type Ⅱ: the volume of epidural hematoma in the injured side was as much as in the contralateral side(subdural hematoma or contusion and laceration of brain with hematoma) in 29 cases, type Ⅲ: hematoma was mainly in the contralateral side(subdural hematoma or contusion and laceration of brain with hematoma)(48 cases). Corresponding operation strategies in the three types patients were taken. Results〓Epidural hematoma in the injured side of type I patients should be taken operation treatment firstly, in the contralateral side, whether to take operation depends on the conditions of preoperative (to take operation with the indication of surgery) and postoperative (review of CT, if hematoma increases to the surgical indication, evacuating hematoma; if not, taking intracranial pressure monitoring); according to GCS score and pupil of type Ⅱ patients without the indication of surgery to decided whether to take operation, if reached, evacuating bilateral hematomas; for type Ⅲ patients, at first drilling drainage in the injured side, reclearing contralateral hematoma, using intraoperative ultrasonography to detect the hematoma of the injured side with the demand of the further treatment or not. According to GOS score to judge the prognosis of patients with good prognosis, of which 45 cases, mild disability in 22 cases, severe disability in 11 cases, plant survival of 11 cases, 8 cases of death. Conclusion〓Patients with bilateral intracranial hematoma caused by contrecoup craniocerebral injury should be treated with corresponding operation strategy according to the CT preoperatively: They can achieve good prognosis.

Key words: Contrecoup craniocerebral injury, Bilateral hematoma, Intra-operative ultrasonography, intracranial pressure monitoring, craniotomy