张旭晨,李坤正

创伤性颅脑损伤（TBI）是一种高病死率和高致残率的全球性健康问题，给社会带来沉重负担。手术干预是治疗中、重度TBI，尤其是合并颅内占位性病变和难治性颅内压（ICP）升高的关键手段。本综述系统概述了TBI手术治疗的主要原则。颅内压监测是重型TBI管理的核心环节，尽管其应用价值存在一定争议，但在资源充足的环境下对于预防继发性脑损伤至关重要。开颅术是清除颅内血肿、中断颅内高压恶性循环的基础手术方式。具体的手术策略因损伤类型而异：对于硬膜外血肿，开颅血肿清除是首选且通常有效的方法；对于急性硬膜下血肿，则在开颅血肿清除与去骨瓣减压术（DC）之间存在选择争议；对于创伤性脑出血与挫伤，手术决策需综合考量血肿体积、占位效应及神经功能状态。最后，颅骨成形术用于修复去骨瓣减压术或创伤造成的颅骨缺损，不仅能恢复生理结构、治疗环钻综合征，还能改善神经功能与脑灌注。尽管外科技术与证据不断演进，但许多领域仍需通过更高质量的临床研究来优化治疗策略，最终改善TBI患者的预后。

创伤性颅脑损伤；手术治疗；颅内压监测；开颅术；去骨瓣减压术；硬膜外血肿；急性硬膜下血肿；创伤性脑出血；颅骨成形术；继发性脑损伤

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