Clinical Observation Of Craniocerebral Trauma Underwent V-P Shunt And Cranioplasty

Objective:After decompressive craniotomy,the symptom of cranial defect combined with hydrocephalus, it will be treated by ventriculo-peritoneal shut, V-P shunt and cranioplasty during the same period. After6months follow-up, we will explore the clinical therapeutic effect and feasibility of the treatment, guiding for clinicians to choose the best treatment plan.Method:From January2010to December2012, through the decompressive craniotomy surgery,22patients with craniocerebral trauma were selected. Then they have different degree of hydrocephalus and cranial defect. Among them16cases are male,6cases are female. The age range is from20to61years old, with an average age of34.62years. There are14cases of traffic accident injuries,4cases of the combat injuries,3cases of falls, and only1case of other causes injury. According to CT detection, the frontal temporal subdural hematoma with cerebral contusion is11cases,6cases with brain hematoma,5cases with diffuse brain swelling.22patients were performed hematoma removal to bone flap craniotomy decompression surgery, unilateral decompression was18cases,4cases were bilateral decompression, skull defect area was6*8～10*12cm, to some extent postoperative hydrocephalus took on. During the same period taking the methods of V-P shunt and the cranioplasty, and the intraoperative first V-P shunt, bulging make brain tissue retracted to bone window plane, then make the repair to the skull. For the patients with postoperative follow-up for6months, to observe the curative effect and complications, using GCS, GOS, KPS score system, compare the preoperative and postoperative recovery of consciousness, evaluation of patient’s prognosis and quality of life; Statistical analysis of the postoperative complications, judge the security of the implementation for two operation.Result:There are different degrees of improvement with the postoperative clinical surgery including consciousness, nerve function and the quality of life.1) GCS score: preoperative,8.92±5.63; Postoperative1w,12.63±2.92, P<0.05.(2) The GOS score:6months after review,4.86±0.35,19cases recovered well (5points), accounting for86.4%; Mild disability,(4),3cases, accounting for13.6%.(3) KPS score:6months after evaluation,78.63+4.68;90points in one case;80points in17cases;4cases of70points. Complications:3cases appear complications, the shunt pipe blockage takes on in1case, subcutaneous effusion arises in2cases, and the total incidence is13.63%;(5) imaging:a review of skull CT,20cases (90.9%) hydrocephalus disappeared, ventricle significantly reduced to normal size. Line above, according to the results of the same period, the effect of V-P shunt and the cranioplasty curative is better and with less complication.Conclusion:the method of conducting V-P shunt and cranioplasty,at the same time, the treatment of cranial defect combined with hydrocephalus is safe and feasible, and has good curative effect. Operation during this period increases the synergies effect of V-P shunt and cranioplasty, implements the early repair of skull as early as possible to protect the nervous system, promote the nerve functional recovery, reduce patient’s clinical symptoms and psychological stress and improve the life quality of patients. At the same time, reduce the risk of surgery and anesthesia; reduce the economic burden of the patients. Therefore, after decompressive craniotomy,the method of treating cranial defect combined with hydrocephalus by one-age V-P shunt and cranioplasty is worthy of further promotion and application in clinical practice.