The Clinical Effect Of Decompressed Craniectomy For Acute Cerebral Heimispheric Swelling After Traumatic Brain Injury

Objective:To prospectively investigate effects and factors associated with clinical outcomes of decompressive hemicraniectomy(DC) on patients with acute cerebral hemispheric swelling (ACHS) after traumatic brain injury and discuss the effective difference between large and routine bone flaps. Methods:All 76 patients with ACHS after brain trauma were studied retrospectively. Decompressive craniectomy with large bone flap was performed in 40 patients and deeompressive craniectomy with routine bone flap was performed in 36 patients. The alteration of intracranial pressure(ICP), The changes in the qualitative CT features (the perimesencephalic cisterns), postoperative complications, Glasgow outcome scores(GOS) on follow-up of 3 months were compared. Results:For large bone flap, the mean ICP values were 30.2±3.0 mm Hg before decompression and 19.8±3.0 mm Hg after decompression. For routine bone flap, the mean ICP values were 30.8±2.6 mm Hg during DC and 22.9±4.2mm Hg after DC. ICP was lower in large flap group than in routine flap group at hour 24 after DC(P<0.05). Brain CT shows the compressed perimesencephalic cisterns is more obvious,the mortality rate is higher.After DC,the mortality rate of the compressed perimesencephalic cisterns reduced group was lower than without the change or adds group. GOS at 3 month follow-up,In the group of large bone flap,23 patients had a good recovery or a moderate disability,9 patients had a severe disability or a vegetative state and 8 patients died. In the group of routine bone flap,11 patients had a good recovery or moderate disability,9 patients had a severe disability or a vegetative state and 16 patients died. The difference of therapeutic effect between these two groups is significant. There was no statistically significant difference on the incidence of postoperative complications, including delayed hematoma, incision cerebrospinal fluid fistula, encephalomyelocele, traumatic epilepsy,and intracranial infection as well. (P<0.05). Conclusion:For decompressive hemicraniectomy on patients with acute cerebral hemispheric swelling (ACHS) after traumatic brain injury, large bone flaps can significantly decrease the ICP,improve the conditions of CT imaging, has better clinical effects than routine bone flaps. There was no statistically significant difference on the incidence of postoperative common complications.