Therapeutic Effect Study Of Subgaleal Drainage In The Treatment Of Traumatic Subdural Effusion

1. BackgroundTraumatic subdural effusion is one of the common complications of traumatic brain injury.It was reported to occur in about 1～10% traumatic brain injury cases.Despite its common occurrence,as its pathogenesis and clinical significance are uncertain,it is still an intractable disease for clinical doctor.In most cases,conservative treatment is enough.But there are still some cases that need surgical intervention.The major surgical techniques include burr hole drainage, transfixion via subdural space and cistern and subduroperitoneal shunt.Burr hole drainage is the most common use technique,which is considered to be the first-line approach.Although these techniques are efficacious,.there are some problems that limited their use.It is still difficulty to establish a new surgical technique which is easy to handle and efficient with little interference to brain.2. ObjectiveTo explore the therapeutic effect of subgaleal drainage in the treatment of traumatic subdural effusion.3. MethodsA total of 35 patients treated by burr hole drainage or subgaleal drainage fortraumatic subdural effusion at the Neurosurgery Department of the Second Hospital Affiliated to Medical College of Zhejiang University were included in this retrospective study.3.1 Diagnosis and rules for case chosen1) Computerized tomography after traumatic brain injury shows crescent-shapedlesion of a density similar to cerebral spinal fluid under the inner plate of skull,with noenhancement .2)Treated by burr hole drainage or subgaleal drainage.3)Cases that were induced probably by surgery, infection or some other reasons wereexcluded in this study.3.2 Clinical materialsAll the cases were divided into two groups by different surgical approach..In the burr hole drainage group,there were 24 cases,with 21 males and 3 females,aged from 15 to 83 years(55.8 years on average).In the subgaleal drainage group,there were 11 cases,with 10 males and 1 females,aged from 0.5 to 79 years(47.7 on average).3.3 TreatmentAll the cases were treated by burr hole drainage or subgaleal drainage when subdural effusion rapidly enlarged showed by computerized tomography, or clinical symptom deteriorated.Treatment after operation:Change according to the patients' clinical presentation, mainly include Lying down,less or no use of dehydrating agent,strictly controlling of inter cranial pressure,raising blood pressure properly,promoting cerebral expansion and usingantibiotics as routine.3.4 Therapeutic effect evaluatedAccording to some articles and the pathogenesis characteristics of traumatic subdural effusion,we chose some factors to see whether there is any difference between the two groups: Glasgow coma scale, average age, construction of age, effusion position, interval from trauma to operation and effusion color.Therapeutic effect of the two surgical techniques was evaluated and compared based on computerized tomography findings and the clinical condition in the 12～80(37 on average) months' follow-up.Therapeutic effect is described as cured, improved and failure.4. ResultsThere are no significant differences between the two groups in average age(p=0.279), construction of age(p=0.099), effusion position(p=0.970), Glasgow coma scale(p=0.327), interval from trauma to operation(p=0.263), effusion color(p=1.000) and effectiveness ratio(p=0.726).3 out of 24 cases treated by burr hole drainage failed.All cases treated by subgaleal drainage were cured(6 cases) or on the mend(5 cases).There were no complications such as infection or tension pneumocephalus, no recurrence with 13～64 months' follow-up.5. ConclusionSubgaleal drainage is easy to handle with good therapeutic effect.We suggest that it can be the first-line surgical approach for traumatic subdural effusion.