外科-頭的各類損害課件

HeadTraumaHeadTraumaHistory15thCenturyGreekpaintingHistory15thCenturyGreekpainOutlineScalpInjurySkullFracturesHemorrhagicContusionIntracranialHematoma

EpiduralHematomaSubduralHematomaIntracerebralHematomaOutlineScalpInjuryScalpInjuryScalpInjuryScalpAnatomyScalpAnatomyScalpInjuryandTreatmentLaceration----Debridement（清創(chuàng)）Avulsion----Grafting;DermoplastySub-galeaHematoma----Observe;EvacuationandCompressionScalpInjuryandTreatmentLaceAvulsionAvulsionSkullFractureSkullFractureSimplelinearfractureSimplelinearfractureTreatmentObserveWatchoutforthecomplications:Intracranialhematoma,etal.TreatmentObserveDepressedSkullFractureDepressedSkullFractureIndicationsforTreatment>8-10mmdepressionDeficitrelatedtounderlyingbrainCSFleakOpendepressedfractureIndicationsforTreatment>8-10Treatment16thCenturyGermanpainting(Gersdorff)Treatment16thCenturyGermanpTreatmentCranioplastyfortheEarthquakeSurvivorTreatmentCranioplastyfortheBasalSkullFracturesBasalSkullFracturesBasalSkullFracturesAnteriorskullbaseMiddlecranialfossaPosteriorcranialfossaBasalSkullFracturesAnteriorDiagnosisRadiographicdiagnosisPlainskullx-rays:Indirectfindings;pneumocephalus(氣顱);air/fluidlevelwithinairsinusCT:poorsensitivityClinicaldiagnosisCSFotorrhea(耳漏)orrhinorrhea（鼻漏）Postauricularecchymoses(Battle’ssign)PeriorbitalecchymoseswithoutdirectorbitaltraumaCranialnerveinjury:I,II,VI,VII,VIII,etal.

DiagnosisRadiographicdiagnosiAnteriorskullbasePanda’seyes?AnteriorskullbasePanda’seyeAnteriorskullbaseRaccoon’seyesAnteriorskullbaseRaccoon’seTreatmentProphylacticantibiotics80%donotrequirespecialtreatmentConditionsthatneedspecifictreatmentTraumaticaneurysmsPost-traumaticCCFCSFfistulaMeningitisorabscessCosmeticdeformitiesPost-traumaticfacialpalsy

TreatmentProphylacticantibiotHemorrhagicContusionHemorrhagicContusionHemorrhagicContusionHemorrhagicContusionDiagnosisCTfindings:HighdentisyareasonCTSometimesenlargewithtimeasseenonserialCTsDiagnosisCTfindings:HighdenDay1Day2Day1Day2Day3Day10Day3Day10TreatmentObserveSurgicaldecompressionmaysometimesbeconsideredifherniationthreatensTreatmentObserveIntracranialHematomaIntracranialHematomaIntracranialHematomaEpiduralSubduralIntra-cerebralIntracranialHematomaEpiduralEpiduralHematomaEpiduralHematomaEpiduralHematoma(EDH)1%ofheadtraumaadmissionsSourceofbleeding:85%Arterialbleeding(mostcommon:MiddleMeningealArtery)Overallmortality:20-55%.Optimaldiagnosisandtreatmentwithinhoursresultsin5-10%mortalityEpiduralHematoma(EDH)1%ofhPresentationofEDHBriefposttraumaticlossofconsiousnessFollowedbya“l(fā)ucidinterval”forseveralhoursHighICP,contralateralhemiparesis,ipsilateralpupillarydialationandherniationPresentationofEDHBriefposttSymptomsandSignsHeadacheVomitingPapilledemaVaryingdegreesofcranialnervepalsiesVitalsigns(Cushing’striad)SymptomsandSignsHeadacheEvaluationPlainskullX-rays(40%nofracture)CTscan:HighdensitybiconvexshapeadjacenttotheskullEvaluationPlainskullX-rays(EpiduralHematoma(EDH)biconvexshapehighdensityEpiduralHematoma(EDH)biconveHighdensitybiconvexshapeadjacenttotheskullEpiduralHematoma(EDH)HighdensitybiconvexshapeadAcuteSubduralHematomaAcuteSubduralHematomaTwotimestheincidenceofacuteEDHImpactdamageisusuallymuchhigherthaninEDH.Morelethal!Symptomsdueto:1.Compressionofunderlyingbrain2.Parenchymalbraininjury3.CerebraledemaAcuteSubduralHematomaTwotimestheincidenceofacuPresentationsSevereunderlyingprimarybraininjuryOftenno“l(fā)ucidinterval”FocalsignsusuallyoccurlaterthanEDHPresentationsSevereunderlyingSymptomsandSignsHeadacheVomitingPapilledemaVaryingdegreesofcranialnervepalsiesVitalsigns(Cushing’striad)SymptomsandSignsHeadacheEvaluationCT:1.Crescentic(新月形)mass,increasedattenuationadjacenttoinnertable2.EdemaEvaluationCT:SubduralHematomaCrescenticmass,increasedattenuationadjacenttoinnertableSubduralHematomaCrescenticmaAcuteIntracerebralHematomaAcuteIntracerebralHematomaImpactdamageisusuallymuchhigherthaninsubduralhematoma.Worst!Symptomsdueto:1.Primaryparenchymalbraininjury2.Compressionofsurroundingbraintissue3.CerebraledemaAcuteIntracerebralHematomaImpactdamageisusuallymuchPresentationsSevereunderlyingprimarybraininjuryNo“l(fā)ucidinterval”Focalsigns:Hemiparesis,etal.PresentationsSevereunderlyingSymptomsandSignsHeadacheVomitingPapilledemaVaryingdegreesofcranialnervepalsiesVitalsigns(Cushing’striad)SymptomsandSignsHeadacheEvaluationCT:1.Intra-cerebralhighdensitymass2.EdemaEvaluationCT:外科-頭的各類損害課件外科-頭的各類損害課件TreatmentforintracranialhematomaE/Rmanagement:HOBelevation;neurochecks;etal.Specificmanagement:ICPmonitoringSedationandparalyticsIntubationandHyperventilationDehydrationProphylacticantiepilepticdrugsTreatmentforintracranialhemSurgicaltreatmentIndications:Supra-tentorial>30mlInfra-tentorial>10mlCraniotomyBurrholesexplorationSurgicaltreatmentIndications:HistoryTrepanningsetBourgery,19thCenturyHistoryTrepanningsetIllustratedcase20-year-oldmale,CTscan20minutesaftertraumaIllustratedcase20-year-oldmaCTscan:4hoursaftertraumaCTscan:SkinincisionSkinincisionSkinflapSkinflapBurrHolesBurrHolesBoneflapandhematomaBoneflapandhematomaPost-operativecontrolCTPost-operativecontrolCTBurrholesex