neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.63769/1683-3295-2017-0-2-21-28neurosurgery-398Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTРанняя компьютерная томография при ушибах головного мозгаEarly computer tomography in patients with brain contusionsСмирновПавел ВасильевичSmirnovP. V.pavliksmirnov@yandex.ruКравецЛеонид ЯковлевичKravetsL. Ya.Lkravetz@yandex.ruЯкимовВасилий НиколаевичYakimovV. N.noemail@neicon.ru«Городская клиническая больница № 39» г. Нижнего НовгородаRussian FederationФГБУ «Приволжский Федеральный Медицинский Исследовательский Центр» МЗ РФRussian FederationНациональный исследовательский Нижегородский государственный университет им. Н.И. ЛобачевскогоRussian Federation201724112017022128Copyright © Смирнов П.В., Кравец Л.Я., Якимов В.Н., 20172017Смирнов П.В., Кравец Л.Я., Якимов В.Н.Smirnov P.V., Kravets L.Y., Yakimov V.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/398

Цель. Обоснование критических подходов к оценке результатов ранней компьютерной томографии (КТ) у пациентов с очаговыми травматическими повреждениями головного мозга в остром периоде черепно-мозговой травмы (ЧМТ). Материалы и методы. У 109 пострадавших в остром периоде ЧМТ в общей сложности было выявлено 209 очаговых повреждений головного мозга, объемная динамика которых отслеживалась в дальнейшем при первичной и повторных КТ. Оценку общей КТ-картины производили по шкалам Marshall и Rotterdam, в баллах оценивающих маркеры отека мозга и выраженность масс-эффекта при контузионных очагах. Результаты. Выявлены закономерности в особенностях нарастания объема геморрагического компонента травматических очагов, который имел тем меньшие исходные размеры (p < 0.001), чем короче был отрезок времени, прошедший с момента травмы до их обнаружения на первичной КТ головного мозга. Отсутствовала прямая взаимосвязь между прогрессией очагов и клиническим статусом, что обусловлено различными реакциями мозга на расширение зоны повреждения. Заключение. «Ранние» (от 15 мин до 2 ч) КТ-исследования в остром периоде ЧМТ диагностируют промежуточную тяжесть повреждений мозга, эволюция которых заканчивается в более поздние сроки. На основании специальных шкал оценки КТ картины в динамике были выделены «значимая» прогрессия травматических очагов с нарастанием масс-эффекта и «незначимая» - без такового.

Objective: To validate the critical approach to the results of early computed tomography in patients with focal traumatic brain injury in the acute period of TBI. Material and methods: Data of 109 patients in acute period of TBI with total number of 209 focal brain lesions were analyzed. The volume dynamics of the lesions was monitored in primary and follow-up CT-scans. The common estimation of CT images was conducted using the Marshall and Rotterdam classifications in comparison with dynamics of clinical signs. Results: It was revealed that the lesion volume increased due to hemorrhagic component of the traumatic lesions, which was the smaller as shorter was the time period from trauma to their detection on a primary brain CT scan. There was not found any correlation between the lesions progression and the clinical status, that may be due to different brain reactions on the injured zone enlargement. Conclusion: “Early” (15 minutes - 2 hours) computed tomography studies in acute period of TBI do not reflect the real severity of brain damage, the evolution of which is still going on and ends later. The usage of the special CT-scales in dynamics allows selecting “important” progression of traumatic lesions with mass-effect increasing and “unimportant” without it.

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The authors declare that there are no conflicts of interest present.