Effect Of Drainage Of Perimesencephalic Cistern Cerebrospinal Fluid During Surgery For Incision Of Tentorium Cerebelli Hiatus On Intracranial Pressure In Patients With Transtentorial Herniae Produced By Traumatic Brain Injury

Objective To study the effect of draining the perimesencephalic cistern cerebrospinal fluid (CSF) during the surgery for incision of tentorium cerebelli hiatus on intracranial pressure (ICP) in patients with transtentorial herniae produced by traumatic brain injury(TBI),in order to improve the decompression effect and reduce mortality and mutilation rate. This process can accordingly provide a reference for clinical treatment and surgery method.Methods Forty patients with transtentorial herniae produced by TBI, who were treated in our hospital from July,2008 to May,2009, were randomly divided into two groups.Both groups were no significantly differences in gender,age,injury,and dilated pupils. Observed group(20cases) in which the drainage of ambient cistern CSF was performed during the surgery for incision of tentorium cerebelli hiatus and control group(20cases) was not done. ICP was determined before and after incision of tentorium cerebelli hiatus and monitored in both groups for five days after surgery. And the visualization of perimesencephalic cistern was observed before and after surgery. GOS was evaluated at 6 months follow up.All patients got the same treatment after surgery.Result The average ICP (mmHg) of the observed group was respectively 4.45±4.78,14.60±4.91,15.30±3.61,15.60±3.62, 14.55±3.55,13.65±3.01 at 1h,1d,2d,3d,4d,5d after surgery, and it's lower than that of the control group (P＜0.05). And the average pressure of lateral ventricle was reduced by 7.30±1.92mmHg after full drainage for the observed group, which was higher than that of the control group,which was 6.00±1.78 mmHg after surgery. In observed group, the average ICP (mmHg)of the CSF drainage volume≥35ml (12cases)was lower than that of the CSF drainage volume＜35ml (8cases)on every main timing point after surgery.The visualization of perimesencephalic cistern after 48 hours surgery was improved,but no significant difference between the two groups.Conclusions1. The drainage of the ambient cistern CSF during incision of tentorium cerebelli hiatus can make the cycle of CSF free,and significantly decrease ICP in patients with transtentorial herniae produced by TBI.2. Thoroughly drainage of the ambient cistern CSF can further improve the decompression effect.3.The drainage of the perimesecephalic cistera CSF can play the role of CSF replacement, decrease the brain injury and vasospasm by bloody CSF.