Introduction

Temporal engagement may persist after etiologic surgical treatment of acute subdural hematoma (ASH) without clinical improvement despite normalized intracranial pressure (ICP). The aim of this study was to assess the feasibility of secondary direct temporal lobe disengagement (DTLD) after surgery for supratentorial ASH and to evaluate clinical outcome.

Materials and methods

This was a retrospective analysis of 4 patients undergoing secondary DTLD. Patient data were recorded at admission, pre- and postoperatively and at 6 months’ follow-up (FU): age, gender, Rotterdam score, Glasgow Coma Scale (GCS), neurological deficits, oculomotor nerve palsy (ONP), ICP, midline shift, complications and Extended Glasgow Outcome Scale (GOS-E).

Results

At postoperative evaluation 48 h after DTLD, we observed a significant improvement in GCS score (initial 6 ± 3, preoperative 7 ± 3, postoperative 14 ± 1; P = 0.02), midline shift (initial 16 ± 3 mm, preoperative 13 ± 5 mm, postoperative 9 ± 2 mm; P = 0.049) and ONP (P = 0.01). In all cases, early postoperative imaging documented visualization of a patent ipsilateral peri-mesencephalic cistern. At 6-month FU, GOS-E showed 75% good recovery and 25% disability. Complete ONP recovery was observed in 75% of patients (P = 0.01). Neurological deficits were present at FU in 25% of patients. No surgery-related complications or mortality were recorded.

Conclusions

In traumatic brain injury, secondary DTLD may allow simple, effective and safe management of trans-tentorial uncal herniation, avoiding more challenging procedures. Clinical results are promising, as this technique seems to favorably influence neurological outcome in this selected subgroup of patients with persistent clinical and radiological signs of temporal engagement after etiological treatment with normal ICP values.

中文翻译：

---

持续性创伤后经小脑幕脑疝的外科治疗

介绍

尽管颅内压 (ICP) 正常化，但在对急性硬膜下血肿 (ASH) 进行病因性手术治疗后，时间接触可能会持续存在，但临床症状没有改善。本研究的目的是评估幕上 ASH 手术后二次直接颞叶脱离 (DTLD) 的可行性并评估临床结果。

材料和方法

这是对 4 名接受继发性 DTLD 的患者的回顾性分析。在入院、术前和术后以及 6 个月的随访 (FU) 时记录患者数据：年龄、性别、鹿特丹评分、格拉斯哥昏迷量表 (GCS)、神经功能缺损、动眼神经麻痹 (ONP)、ICP、中线转移、并发症和扩展格拉斯哥结局量表 (GOS-E)。

结果

在 DTLD 后48小时的术后评估中，我们观察到 GCS 评分显着改善（初始 6  ±  3，术前 7  ±  3，术后 14  ±  1；P  =  0.02），中线偏移（初始 16  ±  3  mm，术前 13  ±  5 毫米，术后 9  ±  2 毫米；P  =  0.049) 和 ONP ( P  =  0.01)。在所有情况下，术后早期成像记录了同侧中脑周围池开放的可视化。在 6 个月的 FU 时，GOS-E 显示出 75% 的良好恢复和 25% 的残疾。在 75% 的患者中观察到 ONP 完全恢复（P =  0.01）。25% 的患者在 FU 时存在神经功能缺损。没有记录与手术相关的并发症或死亡率。

结论

在创伤性脑损伤中，继发性 DTLD 可以简单、有效和安全地管理跨小脑幕疝，避免更具挑战性的手术。临床结果是有希望的，因为该技术似乎对这一选定亚组患者的神经系统结果产生了有利影响，这些患者在使用正常 ICP 值进行病因治疗后，具有持续的临床和放射学时间参与迹象。