Method of diagnostics and surgical approach to treatment of craniocerebral trauma in children

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, in particular, to neurosurgery. Minimal diametre of trepanation is calculated by formula: where: D1 is diametre in case if unilateral trepanation is performed; D2 is diametre in case of bilateral trepanation; W is mass-effect of trauma (%), which is calculated for patients with presence or absence of additional intracranial formation: hematoma, hydroma, hygroma, contusion focus, by given mathematical formulae. During calculation of mass-effect taken into account are: volume of additional formation, in cubic cm, and estimation of patient's state by GLASGO scale.

EFFECT: method makes it possible to determine optimal dimensions of trepanation hole for carrying out operations of decompression orientation in treatment of craniocerebral trauma in children.

2 tbl

 

The invention relates to medicine, in particular to neurosurgery, pediatric surgery, and can be applied in the choice of tactics of surgical intervention in children with traumatic brain injury.

Progressive persistent intracranial hypertension, characteristic of traumatic brain injury and do not respond to conservative therapy is an indication for surgery decompressive direction to create a backup space.

There are several ways to determine the size of trephination. In adult patients Bed, Too, Wmiprov [1, 2, 3, 6] suggested that bone-plastic trepanning with window size not less than 9×7×8 cm, URS [4] - not less than 12×15 cm In children A. Taylor [7] noted the positive effect from the trephination 4×4 see, However, the above methods are empirical and do not take into account the size of volumetric effects in trauma, as well as individual craniometric parameters, which is especially important in children.

According to A. M. Nikulin [5], a backup volume when conducting trephination with a diameter of 6 cm is 9 cm3; when the diameter of trephination 8 cm - 25 cm3; when the diameter trepanation window 10 cm - 55 cm3.

The objective of the invention is to improve the accuracy of calculation of the diameter trepanation holes when conducting operations at the children with craniocerebral trauma.

The invention consists in the method of calculation of the diameter trepanation holes (for unilateral or bilateral trephination), according to the invention, based on the estimated mass effect trauma, as well as the circumference of the patient's head.

The method is as follows.

The following data is collected: the results of clinical examination, measure the circumference of the head, in the presence of post-traumatic intracranial lesion is measured for its volume (CT studies). The obtained data are interpreted as follows:

1. Head circumference, cm (corresponds to the variable "L").

2. In the presence of post-traumatic lesion (hematoma, gidromy, hygroma) - the total volume, cm3(the variable "G").

3. Stem signs, in accordance with the methodology for the assessment of neurological symptoms (variable S): 4 - there are no violations, 3 - initial disturbance - reduced corneal reflexes, clonic spontaneous nystagmus, minor anisocoria, 2 - expressed human - expressed anisocoria, clinico-tonic nystagmus, reduced reaction of pupils to light, moderate paresis of upward gaze, bilateral pathological signs, 1 - gross violations - rough anisocoria, rough paresis of upward gaze, tonic multiple spontaneous NIST is GM or floating eyes, symptom of Hertwig-Morandi, roughly pronounced pathological signs, convulsions, 0 - critical violations bilateral mydriasis with no pupils to light, areflexia, muscular atony.

4. Hemispheric and craniobasal signs, in accordance with the methods of neurological assessment (variable "K"): 4 - there are no violations, 3 - initial violations reduced or absent abdominal reflexes, a unilateral increase in tendon reflexes, moderately expressed pathological signs on the one hand, soft mono - or hemiparesis, mild speech defects, 2 - expressed human pronounced mono - or hemiparesis expressed paresis of cranial nerves, expressed speech disturbances, seizures clonic or clinico-tonic convulsions in konechnostej, 1 - gross violations - roughly pronounced mono - or hemiparesis, or paralysis, rough speech disturbances, often repetitive clinico-tonic spasms in the extremities, 0 - critical violations - tripart, triplegia, tetraparesis, quadriplegia, bilateral facial paresis, aphasia, constant cramps in the extremities.

5. Vital disorders, taking into account age-related norms, in accordance with the methodology for the assessment of neurological symptoms (variable "VIT"): 4 - there are no violations, 3 - initial disturbance - moderate bradycardia or moderate tachycardia, moderate tachypnea, reasonable arter the real Hyper - or hypotension, subfebrility, 2 - expressed human - sharp of the or bradypnoea, sudden tachycardia, sudden arterial Hyper - or hypotension, severe fever, 1 - gross violations - an extreme degree of the or bradypnoea, extreme Brady - or tachycardia, extreme arterial Hyper - or hypotonia, severe hyperthermia, 0 - critical violations - pathological types or stops breathing, the maximum reduction in blood pressure, nesochetaemyh heart rate, hyperthermia.

The diameter of trephination is calculated as follows

;

;

where D1 is the diameter when conducting unilateral trephination;

D2 is the diameter when conducting bilateral trephination;

W - mass-effect injury (in percentage units).

Conclusion about the magnitude of the mass effect of the injury is carried out according to the formulae given in tables 1,2.

Table 1.
Calculation of mass effect for patients with intracranial education (hematoma, hydroma, hygroma, a contusion focus):
The estimated mass effect (W)The formula for calculating the probability P(%)
<5%P1=100*(1/(1+e-(2,65-73.00*V+1.62*(G) ))*(1/(1+e(-(20.64+6.88*S+6.88*K)))
from 5 to 12%P2=100*(1/(1+e-(2,65-73.00*V+13.62*G)))*(1-(1/(1+e(20.64+6.88*S+6.88*K))))
from 12 to 20%P3=100*(1-(1/(1+e-(2,65-73.00*V+13.62*G))))*(1/(1+e-(-9.89+8.79*VIT)))
>20%P4=100*(1-(1/(1+e-(2,65-73.00*V+13.62*G))))*(1-(1/(1+e(9.89+8.79*VIT))))
V is the volume of the hematoma, CC, G - score scale GLASGO (if the score on the scale GLASLO>4, G=1, otherwise G=0); S - stem signs, K - hemispheric and craniobasal signs, VIT - vital violations.

Table 2.
Calculation of mass effect for patients with no intracranial education (hematoma, hydroma, hygroma, a contusion focus):
The estimated mass effectThe formula to calculate the probability (%)
<5%P1=100*(1/(1+e-(25,84+6.63*GLASGO)))*(1/(1+e(-(20.64+6.88*S+6.88*K)))
from 5 to 12%P2=100*(1/(1+e-(25,84+6.63*GLASGO)))*(1-(1/(1+e-(20.64+6.88*S+6.88*K))))
from 12 to 20% P3=100*(1-(1/(1+e-(25,84+6.63*GLASGO))))*(1/(1+e-(-9.89+8.79*VIT)))
>20%P3=100*(1-(1/(1+e-(25,84+6.63*GLASGO))))*(1-(1/(1+e-(-9.89+8.79*VIT))))
GLASGO - assessment on a scale GLASGO in points, S - stem signs, hemispheric and craniobasal signs, VIT - vital violations.

The proposed method of calculating the diameter trepanation holes are easy to use and is possible even in the absence of high-tech imaging techniques.

The technical result of the application of the method is to achieve the maximum effect from operations decompressive direction in the surgical treatment of traumatic brain injury in children.

Sources of information

1. Zotov J.V., sedrenik CENTURIES Surgery traumatic intracranial haematomas and crush zone of the brain, str.

2. Lebedev V.V., Wenselowski Volume of surgical intervention in traumatic intracranial hematomas. Intracranial hemorrhage. Collection of scientific works of the Institute. Nevskogo. M., 1982. P. - 34-40.

3. Lebedev V.V. Zherikhin, V.V. Krylov Emergency surgery: a Guide for physicians. M, Medicine. 2000 - 568 S.

4. Pores J.V. selection Method craniotomy for traumatic subdural, intracerebral hematoma and traumatize the fir brain injury, dis.... Kida. the honey. Sciences / URS. - Moscow, 2007. - 45 S.

5. Nikulin A.M. Anatomical rationale for the size and localization trepanation holes in the surgical treatment of traumatic intracranial hematomas / Amerikuli // Matters. of neurosurgery. - 1988. No. 5. - P.6.

6. Ugryumov V.M. Severe closed traumatic brain injury. Publishing house "Medicine", 1974, 234 S.

7. Taylor, A., Warwick C., Rosenfeld, J., et al.: A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv. Syst. 2001; 17:154-162.

The method of calculation of the diameter trepanation holes when conducting unilateral or bilateral decompressive trephination in children with traumatic brain injury, characterized in that the minimum diameter of trephination is calculated by the formula:


where D1 is the diameter when conducting unilateral trephination;
D2 is the diameter when conducting bilateral trephination;
W - mass-effect injury (%), which is assumed to be 5%, if the probability of its occurrence, calculated by the formula
P1=100·(1/(1+e-(2,65-73,00·V+13,62·)))·(1/(1+e-(20,64+6,88·S+6,88·K))) in patients with the presence of intracranial hematoma and
P1=100·(1/(1+e-(25,84+6,63·GLASGO)))·(1/(1+e-(20,64+6,88·S+6,88·K))) in patients with no maximum;
or equal to 12%, if the probability of its occurrence, caters the Naya formula
P2=100·(1/(1+e-(2,65-73,00·V+13,62·G)))·(1-(1/(1+e(20,64+6,88·S+6,88·K)))) in patients with the presence of intracranial hematoma and
P2=100·(1/(1+e-(25,84+6,63·GLASGO)))·(1-(1/(1+e-(20,64+6,88·S+6,88·K)))) in patients with no maximum;
or equal to 20%, if the probability of its occurrence, calculated by the formula
P3=100·(1-(1/(1+e-(2,65-73,00·V+13,62·G))))·(1/(1+e-(-9,89+8,79·VIT))) in patients with the presence of intracranial hematoma and
P3=100·(1-(1/(1+e-(25,84+6,63·GLASGO))))·(1-(1/(1+e-(-9,89+8,79·VIT)))) in patients with no maximum;
where V is the volume of the hematoma, CC; G - score scale GLASGO (if the score on the scale GLASLO>4, G=1, otherwise G=0); GLASGO - assessment on a scale GLASGO in points; the S - stem signs; abstracting and craniobasal signs; VIT - vital violations.



 

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