Clinical Application Research: Improved Frontotemporal Craniectomy With Moderate And Severe Traumatic Brain Injured Patients

Objective Analyze systematically the experience on outcome of 22 braininjured patients with improved frontotemporal craniectomy and explore its clinicalapplication in moderate and severe traumatic brain injury. Methods Improvedfrontotemporal craniectomy base on the Yasargil approach. This method emphasizesthe localized decompression of anterior cranial fossa and middle cranial fossa andstresses the treatment of frustration. The first drill commonly was at key hole. Fortynine patients with an admission Glasgow Coma Scale score (GCSs) of 8 or less wererandomly divided into two groups: improved frontotemporal craniectomy (n=22),routine frontotemporal craniectomy(n=27). GCSs and prognosis of these patients wereobserved after operation. Results Glasgow outcome scale at 10 day follow-upindicated that GCS score is better in improved frontotemporal craniectomy group thanin another group (p＜0.05). One-seven month follow-up graded by GCS score afteroperation showed the following result. Improved frontotemporal craniectomy group:15 cases got favorable outcome (68.2%), including 12 good recoveries and 3moderate deficits; other 7 cases got unfavorable outcome (31.8%), including 2 severedeficits and 1 persistent vegetative status, and 4 were dead. Routine frontotemporalcraniectomy: 13 cases got favorable outcome (48.1%), including 9 good recoveriesand 4 moderate deficits; other 14 cases got unfavorable outcome (51.9%), including 4severe deficits and 3 persistent vegetative statuses, and 7 were dead. There is noapparent difference between these two groups (p＞0.05). Conclusions Improvedfrontotemporal craniectomy was performed successfully and the field was distinctlyexposed. It is easy to handle frustration injury. Proper decompression provided a large space for surgery indicating this method was an ideal one. Comparing with routinefrontotemporal craniectomy, this can effectively improve consciousness recoverylevel after operations. However, there is no apparent difference in long-termtherapeutic effect between these two groups.