Sirko A. Intracranial hypertension at severe traumatic brain injury (diagnostics, prognosis, surgical correction).

The thesis is devoted to the problem of treatment results improving in patients with severe traumatic brain injury (TBI) by timely diagnostics, prevention and active surgical correction of intracranial hypertension (ICH). ICH prognostic factors in the acute period of severe TBI were specified. On the base of transcranial dopplerography and cerebral perfusion pressure data analysis ICH influence on cerebral blood flow (CBF) in patients with severe TBI was determined. Five types of CBF disturbance at severe TBI clinical flow were defined. The dependence of type of CBF disturbance on initial values of intracranial and cerebral perfusion pressure was determined. Prognostic impact of ICH and CBF disturbances on severe TBI clinical flow and outcomes was specified. Relations between type of severe diffuse brain injury (DBI) according to L.F. Marshall classification and ICH occurrence and severity were determined. Expedience of surgical interventions performance at severe DBI was proved, indications for decompressive craniectomy were specified. Quantitative indicators of decompressive craniectomy impact on intracranial and cerebral perfusion pressure and CBF in patients with severe TBI were defined. Recommendations for surgical tactics depending on the TBI type, clinical and computer tomography parameters, ICH severity and duration were developed. Introduction of complex measures for ICH timely diagnostics and active correction allowed to decrease lethality at severe TBI on 21.1% and to increase frequency of favorable treatment results on 23.7%.