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1、附属医院AFFILIATED HOSPITAL OF SOUTHWEST MEDICAL UNIVERSITY附属医院AFFILIATED HOSPITAL OF SOUTHWEST MEDICAL UNIVERSITY发发生率生率脑脑外外伤伤后后脑积脑积水水发发生率生率为为 0.7-2.9%去骨瓣减去骨瓣减压术压术后后脑积脑积水（水（PTH）发发生率生率 JOURNAL OF NEUROTRAUMA (2011)10-40%附属医院AFFILIATED HOSPITAL OF SOUTHWEST MEDICAL UNIVERSITY诊诊断断Evans指数指数MRIICP脑脑室系室系统扩统扩大
2、大去骨瓣后去骨瓣后Evans指数指数还还准嘛？准嘛？骨瓣缺失骨瓣缺失 ICP波波动动？T2间质间质性水性水肿肿？脑脑膨出？膨出？脑脑萎萎缩缩？附属医院AFFILIATED HOSPITAL OF SOUTHWEST MEDICAL UNIVERSITY治治疗疗1.颅颅骨修骨修补补2.脑积脑积水的治水的治疗疗先先补补后分流？先分流后后分流？先分流后补补？同？同时时？V-P？ETV？附属医院AFFILIATED HOSPITAL OF SOUTHWEST MEDICAL UNIVERSITY危危险险因素因素双双侧侧去骨瓣去骨瓣大骨瓣大骨瓣脑脑室内室内积积血血去骨瓣去骨瓣对侧对侧硬膜下硬膜下积积液液
3、颅颅骨修骨修补时间补时间延延迟迟J Korean Neurosurg Soc(2015)独立危独立危险因素因素附属医院AFFILIATED HOSPITAL OF SOUTHWEST MEDICAL UNIVERSITY危危险险因素因素只只与骨瓣与骨瓣边缘边缘与中与中线线的距离有关的距离有关骨瓣骨瓣边缘边缘与中与中线线的的距离距离25mm，去骨瓣减去骨瓣减压压最最主要在于减主要在于减轻颞轻颞部部压压力力尽早修尽早修补颅补颅骨，恢复正常解剖骨，恢复正常解剖在在颅颅内内压监测压监测下手下手术术，尽量小范，尽量小范围围去骨瓣去骨瓣附属医院AFFILIATED HOSPITAL OF SOUTHWEST MEDICAL UNIVERSITY