The application of small dural window exposure for craniectomy in patients with severe brain injury / 中国神经精神疾病杂志

ABSTRACT

Objective To evaluate the application of small dural window exposure strategy for removal of subdu-ral hematomas and decompressive craniectomy in patients with severe brain injury. Methods Eighty patients with an ad-mission Glasgow Coma Scale score of 8 or less were randomly divided into two groupsRoutine craniectomy group (42 pa-tients) and small dural window exposure strategy group (38 patients). The clinical outcomes were compared between these two groups. Results The average quantity of blood transfusion (erythrocyte suspension)at 24 h was 2.85 ± 1.98 and 1.43±1.40 unit in the routine craniectomy group and small dural window exposure strategy group, respectively. The num-bers of the delayed intracranial hematomas, traumatic epileptic seizure as well as acute encephalomyelocele were 10, 12 as well as 9 in the routine craniectomy group and 2, 3 as well as 1 in the small dural window exposure strategy group. However, the time of operate duration and the incidence of cerebral infaction were not significantly different between two groups (P>0.05). After 6-month follow-up, there were 16 cases with favorable outcomes including 10 with good recov-ery and 6 with mild disability and 26 cases with unfavorable outcomes, including 7 with severe deficits, 6 with persistent vegetative status and 13 dead in the routine craniectomy group. In contrast, there were 23 cases with favorable outcomes including 12 good recovery and 11 mild disability and 15 cases with unfavorable outcome including 6 with severe deficits, 4 with persistent vegetative status and 5 dead in the small dural window exposure strategy (P﹤0.05). Conclusion small dural window exposure strategy is an excellent technique for the complete evacuation of the traumatic intracranial hemato-ma, especially those with massive intraoperative swelling .