Clinical Contral Study Of Large Craniectomy Versus Routine Craniectomy Used In Severe Traumatic Head Injury

Objetive : The mortality and morbidity are still high at present. How to find a better method to improve the outcome improve the prognosis is an important task that many neurosurgeries face . At the basis of experimental and clinical research, large trauma craniectomy is thought as a better to improve the outcome. At the same time, a comparision is maken between large craniectomy and routine craniectomy. To compare the clinical effect of treating severe head inguries using the large craniectomy versus the routine craniectomy. The main pathophysiologic progress of severe traumatic brain injury is refractory intracranial hypertension. High ICP can decrease the cerebral blood perfusion, and cause brain hernia ,even brain death. It is a escalating cycle of brain swelling, increased ICP and furture swelling. The ICP relief mainly depend on the variation of CSF and CBF.It will cause significant ICP increasing when the volume of skull increased by 8-10%. When the ICP can not be decreased by conservative therapeutation, the pressure relief must be achieved by decompressive craniectomy . Decompressive craniectomy can low the ICP ,improve the CBF and energy failure, and prevent the escalating of brain swelling. According to the experimental results, the large craniectomy can low ICP effectively. Methods : The summarizing trauma cases in our department from 2000 to 2005 were 2117, and 651 patients were severe traumatic brain injury. We retrospectively analysed 97 patients treated with craniectomy, including 47 large craniectomy decompressive cases and 50 routine decopressive craniectomy. When patients tolerated the large craniectomy, afronto-temporo-parietal bone remove with the following margins: anterior, to the margine of hair ; superior, parellal to the superior...