对于出现颅内疾病引起的经幕上脑疝和瞳孔异常的患者，在急诊减压手术后的存活和功能恢复的预测因素尚未确定。本研究的目的是评估颅内肿瘤、经幕上脑疝和非反应性瞳孔扩张症的患者进行急诊手术减压后的结局。研究回顾性分析了2016年至2022年在两家创伤与中风中心接受颅骨切除术或开颅手术的所有经幕上脑疝和瞳孔异常的患者的病历。功能结果采用修正Rankin量表 (mRS) 进行评定。共纳入了43例患者，包括34名男性和9名女性，平均年龄为47岁 (范围16-92岁)。其中33例患者的潜在病因是头部外伤，8例为出血性中风，2例为肿瘤。术前Glasgow昏迷量表评分的中位数为3 (范围3-8)，中线偏移的中位数为9mm (范围1-29mm)。32例患者 (74.4%) 存在双侧固定和扩张瞳孔。手术时间(从瞳孔变化开始计算)的中位数为133分钟 (平均169分钟, 范围30-900分钟)。术后死亡的患者共有18例 (41.9%)。随访时间中位数为12个月 (范围3-12个月)，11例患者 (26.8%) 的功能恢复良好，而10例患者仍然严重残疾 (mRS分数为5)。在单变量分析中，年轻年龄 (p < 0.001)，中线偏移较小 (p = 0.049) ，以及渗透性疗法或减压手术后改善的瞳孔反应 (p < 0.01) 或减压手术 (p < 0.001) 与3个月有利的结果相关联。 通过积极的医疗和手术管理，包括那些存在双侧固定和扩张瞳孔的经幕上脑疝患者，存活和功能恢复的率可达到相当高的水平。年轻年龄、较小的中线偏移以及在利尿疗法或减压手术后改善的瞳孔反应是有利的预测因素。

The predictors of survival and functional recovery following emergency decompressive surgery in patients with transtentorial brain herniation, particularly those with pupillary abnormalities, have not been established. In this study, the authors aimed to assess the outcome of patients with intracranial mass lesions, transtentorial brain herniation, and nonreactive mydriasis, following emergency surgical decompression.A retrospective chart review was performed of all patients with transtentorial herniation and pupillary abnormalities who underwent craniotomy or craniectomy at two trauma and stroke centers between 2016 and 2022. The functional outcome was determined using the modified Rankin Scale (mRS).Forty-three patients, 34 men and 9 women with a mean age of 47 years (range 16-92 years), were included. The underlying etiology was traumatic brain injury in 33 patients, hemorrhagic stroke in 8 patients, and tumor in 2 patients. The median preoperative Glasgow Coma Scale score was 3 (range 3-8), and the median midline shift was 9 mm (range 1-29 mm). Thirty-two patients (74.4%) had bilaterally fixed and dilated pupils. The median time to surgery (from pupillary changes) was 133 minutes (mean 169 minutes, range 30-900 minutes). Eighteen patients (41.9%) died postoperatively. After a median follow-up of 12 months (range 3-12 months), 11 patients (26.8%) had a favorable functional outcome, while 10 remained severely disabled (mRS score 5). On univariate analysis, younger age (p < 0.001), less midline shift (p = 0.049), and improved pupillary response after osmotic therapy (p < 0.01) or decompressive surgery (p < 0.001) were associated with favorable outcomes at 3 months.With aggressive medical and surgical management, patients with transtentorial brain herniation, including those with bilaterally fixed and dilated pupils, may have considerable rates of survival and functional recovery. Young age, less midline shift, and improved pupillary response following osmotic therapy or decompressive surgery are favorable prognosticators.