Effect of mild hypothermia for treatment of severe head injury: a clinical analysis / 中华神经医学杂志

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.

Clinical significance of bone reconstruction at cranial base for traumatic comminuted fractures of anterior skull base / 中华神经医学杂志

Objective To study the clinical significance of bone reconstruction at cranial base for severe traumatic comminuted fractures of anterior skull base. Methods Forty-six bone defect cases were divided into treatment group and control group randomly. Treatment group was treated with the bone reconstruction therapy, while the control group was not. All the patients received the follow-up ranging 6 months to 1 year, and examined with CT and/or MRI to observe leakage of cerebrospinal fluid,intracranial infection and encephalomeningocele. Results In the treatment group, one of the 18 survivals developed mild cerebrospinal fluid leakage, which was cured later. In the control group, 5 of the 17 survivals had cerebrospinal fluid leakage, 3 had intracranial infection and 3 encephalomeningocele.The total incidence of complications of the treatment and control groups was 1/18 and 5/17, respectively,and the former was significantly lower than the latter (P＜0.05). Conclusions Bone reconstruction can avoid intracranial infection, cerebrospinal fluid leakage and encephalomeningocele during the operation for traumatic comminuted fractures of anterior skull base.

Clinical study of separate interhemispheric subdural effusion / 中华神经医学杂志

Objective To propose the concept of separate interhemispheric subdural effusion, and further study the pathogenesis, diagnosis, treatment and prevention of the disease. Methods 544patients with head injury who were treated by decompressive craniotomy with large bone flap removal (treatment group) or decompressive craniotomy without large bone flap removal (control group) were retrospectively analyzed for understanding the incidence of separate interhemispheric subdural effusion and studying the pathogenesis and risk factors of the disease. Results CT examination showed separate interhemispheric subdural effusion occurred in 38 cases, including 14 of unilateral craniotomy and 24 of bilateral craniotomy, in the treatment group, and 8 cases, including 2 of unilateral craniotomy with disposable bone flap and 6 of bilateral craniotomy with disposable flap, in the control group. The difference in the incidence of separate interhemispheric subdural effusion was significant statistically between treatment and control groups (X2=9.758,P=0.002), but not significant between unilateral and bilateral craniotomies in the two groups (X2=0.053,P=0.818). Conclusions Separate interhemispheric subdural effusion is one type of subdural effusion, and related to brain tissue shift after large bone flap craniotomy. It is one of the most common complications after the craniotomy. It can be diagnosed conveniently by the means of imaging. Early diagnosis and treatment will be beneficial for good prognosis, and to reduce the size of the bone window and to avoid brain tissue shift after operation are the best preventive measures.

Detection of serum S-100B protein in patients with severe head injury receiving mild hypothermia treatment / 中华神经医学杂志

Objective To evaluate the effect of mild hypothermia for brain protection by detecting the changes in serum S-100B protein in patients with severe head injury and investigate the possible mechanism. Methods With 100 healthy volunteers as the control group, 100 patients with severe head injury (Glascow Coma Score ≤ 8) received treatment with mild hypothermia (n=50) or normothermia (n=50). Serum samples were collected from the patients early (2-6 h) after the injury and at 1, 3, 5, 7, and 10 days after the injury to measure the levels of S-100B protein. Results In healthy subjects, the serum level of S-100B protein was not associated with age or gender. Patients with severe head injury receiving mild hypothermia treatment and normothermia treatment showed significant differences in serum S-100B protein level from the control group (P<0.01). The patinets with mild hypothermia treatment had significantly lower serum S-100B level than those treated with normothermia atl, 3, 5, 7, and l0 days after the injury (P<0.05). Conclusion Serum S-100B protein has high sensitivity and specificity in the diagnosis of severe head injury, and may serve as an effective biochemical indicator. Mild hypothermia may protect the brain tissue of patients with severe head injury.