| Part Ⅰ DSA study of intracranial microcirculation and venous circulation in patients acute craniocerebral injuryObjective 1.Digital subtraction angiography(DSA)detects whether there is a correlation between the microcirculation,venous circulation time,injury local venous return disorder,pseudohemangioma and the progress of brain injury in patients with cerebral hypertension(Traumatic brain injury,TBI).2.To study the correlation between cerebral microcirculation and venous circulation time and the number and diameter of large cortical veins in patients with cerebral hypertension after TBI.3.To explore the possible pathophysiological mechanism of the increase in ICP and CCT changes after TBI,and explain the effect of TBI on the intracranial circulatory system.Method Select 15 patients with acute subdural hematoma as test group A,select 18 patients with brain contusion and laceration as test group B,select 19 patients with unruptured intracranial arteries as control group C;use DSA observed and compared the three groups of patients’ Cerebral Circulation time(CCT),Arterial phase time(T1),Microvascular cerebral circulation time(MCCT,T2),Venous cerebral circulation time(VCCT)And the imaging characteristics of cortical veins;two attending doctors in the intervention room measure and calculate the number of cortical veins,measure the diameter of cortical veins near the bridging vein,and calculate the total;local magnification of brain contusion and laceration area to observe whether there is traumatic hemangioma,Venous thrombosis;and regular re-examination of head CT,statistical analysis of the existence of traumatic hemangioma,venous thrombosis and TBI progression.Results In patients with intracranial hypertension after TBI,the time of intracranial microcirculation and venous circulation was significantly prolonged;the time of intracranial microcirculation and venous circulation was closely related to the number and total diameter of cortical veins in patients with TBI,showing a negative correlation;The circulatory and venous circulation time of the injured side was significantly longer than the contralateral side.Conclusion In patients with intracranial hypertension after TBI,the intracranial microcirculation and venous circulation time are significantly prolonged;the intracranial microcirculation and venous circulation time are closely related to the number and total diameter of cortical veins in patients with TBI,and are negatively correlated;intracranial microcirculation The circulatory and venous circulation time of the injured side was significantly longer than the contralateral side.Part Ⅱ Analyses the change of edema area size around brain contusion and laceration and its influencing factorsObjective Observe the difference in the volume of cerebral edema secondary to cerebral contusion and laceration between large cortical vein area and non-cortical large vein area.Method Select 47 patients with cerebral contusion and laceration in the lateral fissure vein,Labbé vein and Trolard vein as the venous group,and 66 patients with cerebral contusion and laceration in other parts as the non-venous group.The clinical and imaging data(GCS score,age,gender,trauma type,imaging image,hematocrit,fibrinogen,D-dimer)of the patient at admission were collected retrospectively.Reexamination of the skull CT(Philips Brilliance 256-slice spiral CT scanner in the Netherlands on the 6h,1d,3d,and 5d after admission.The scanning range is from the top of the skull to the base of the skull.Scanning parameters: tube voltage 120 k V,tube Current 300 m A,slice thickness 5mm,slice distance 5 mm),import the head CT data into the 3D slicer software to calculate the brain injury and edema volume,and record the hematocrit(Hct)within 6 hours and 5 days after injury.,Fibrinogen(Fg),D-dimer(D-dimer,DD)indicators,such as disease progression and reach the indications for surgery will not be compared.Statistical analysis of the difference in edema volume ratio between the two groups.Results Use 3D Slicer software to calculate the volume of brain contusion,hematoma,and surrounding brain tissue edema.On the 5th day after injury,the volume ratio of edema around the cerebral contusion and laceration in the sylvian fissure vein,Labbé vein,and Trolard vein is higher than that in non-venous areas.The ratio of peripheral edema is obviously abnormal,P<0.05;when the physical and chemical factors causing brain edema are basically the same,the biggest factor affecting edema may be the microcirculation and venous circulation in different parts.Conclusion Use 3D Slicer software to calculate the volume of brain contusion,hematoma,and surrounding brain tissue edema.On the 5th day after injury,the volume ratio of edema around the cerebral contusion and laceration in the sylvian fissure vein,Labbé vein,and Trolard vein is higher than that in non-venous areas.The ratio of peripheral edema is obviously abnormal,P<0.05;when the physical and chemical factors causing brain edema are basically the same,the biggest factor affecting edema may be the microcirculation and venous circulation in different parts.Part Ⅲ Preoperative imaging data analysis of patients with acute encephalocele during operation of acute subdural hematomaObjective Retrospectively analyze the correlation between intraoperative encephalocele and subdural hematoma thickness,midline offset distance,CT value,cisternal compression,and lateral ventricle compression.Method We selected 51 patients undergoing emergency surgery for traumatic subdural hematoma from2017.01 to 2020.01.18 patients with intraoperative encephalocele were classified as group A,and 33 patients without intraoperative encephalocele were classified as group B.Measure the CT values of gray matter and white matter on the anterior,middle and posterior three averaging lines at the basal ganglia level and the semi-oval center level(the gray matter measurement point is 10 mm away from the inner surface of the skull inner plate or the inner surface of the hematoma,and the white matter measurement point is away The gray matter measurement site is 15 mm,and the measurement area is about 5mm2.In case of hematoma or cisternal sulcus structure,the measurement site can be moved),the posterior 1/3 of the superior sagittal sinus(can fully identify the sagittal sinus).According to the preoperative skull CT,accurately measure the distance from the midline(the horizontal distance from the midline structure to the midline position),the thickness of the intracranial hematoma(the thickest level from the midline to the lateral hematoma,and the maximum level from the hematoma cortex edge to the inner skull edge)Distance),and calculate the ratio of the offset distance to the thickness of the hematoma,and calculate the difference between the offset length and the thickness of the hematoma.At the same time,the classification of the pressure of the cistern and the scoring factors of the pressure of the lateral ventricle were analyzed;single factor used to explore the risk factors of intraoperative encephalocele.Results The thickness and volume of subdural hematoma in the unexpanded group were slightly larger than those in the unexpanded group,but there was no statistical significance;the midline structure shift in the unexpanded group was significantly greater than that in the unexpanded group,and it was statistically significant;the thickness of the subdural hematoma The difference between the offset distance from the midline,the non-bulging group was significantly greater than that of the bulging group,and it was statistically significant;the preoperative superior sagittal CT value was positively correlated with intraoperative acute encephalocele,and the basal nucleus area CT value was correlated with the surgical Acute encephalocele is negatively correlated.Conclusion The thickness and volume of subdural hematoma in group B(non-encephalocele group)were slightly larger than those in group A(encephalocele group),but it was not statistically significant;the midline structure shift in group A was significantly greater than that in group B,and it was statistically significant;The difference between the thickness of the subdural hematoma and the offset distance of the midline is significantly greater in group B than in group A,and has statistical significance;the ratio of the thickness of subdural hematoma to the offset distance of the midline in group A is greater than that of group B,but has no statistical significance;The higher the CT value of the superior sagittal sinus,the greater the possibility of intraoperative acute encephalocele.The lower the preoperative CT value of gray and white matter at the basal nucleus level,the greater the possibility of intraoperative acute encephalocele.Intraoperative acute encephalocele occurred in patients with grade V of cisternal compression and patients with lateral ventricular compression score of 3points. |
