| 1.Objective:To investigate the therapeutic effects of the surgery in progressive traumatic subdural effusion patients.2.Method:The improved small bone slot surgery was performed in 26 progressive traumatic subdural effusion patients, and conventional operation in 20 control patients.Therapeutic effects were evaluated with statistical methods.2.1. Diagnostic standard and enrollment criteria1) craniocerebral traumatic patients whose CT examination results showed crescent-shaped uniform low density areas with similar density to cerebrospinal fluid under the internal lamina were enrolled. All participants were treated surgically because of the growth of effusion volume in CT imagines and the aggravation of the clinical symptoms.2) Subdural effusion patients induced by craniotomy, infection and other etiologies were excluded.3) Patients were treated with the improved small bone slot surgery trepanation and drainage. 2.2. General information Patients were divided into two treatment groups according to different operation approaches,26 in improved small bone slot drainage group(study group) and 20 in trepanation and drainage group(control group). Study group included 14 male and 12 female patients aged from 9 to 65(average 45.7), and the control group had 11 male and 9 female patients aged from 8 to 63(average 48.5). All patients were examined by CT or MRI for diagnosis, and then treated with improved small bone slot drainage or trepanation and drainage. The CT review results showed that effusion volume was reduced to varying degrees.2.3. Treatments After general or basic plus local anesthesia, improved small bone slot drainage were performed on the basis of CT or MRI results. The straight incision was not exceeding the hairline and 2-3 cm beside the midline with the length of 3 cm. We detected the high pressure of the effusion through puncture needle before we incised the dura mater. After the incision of dura mater, we found pallide-flavens clear or pink liquids in it. We cut the peplos open and released the effusion, and laid a multiaperture drainage tube before closing the skull.Postoperation treatments:Adjusted according to the patients'situations, the postoperation treatments mainly included prostration/head-down affected side-down tilt, reducing or withdraw excessive dehydration agents, controlling ICP, augmentation of fluid replacement volume, raising BP appropriately, promoting the reposition of the brain tissue. Antibiotics were routinely used for prophylaxis of infection.2.4. Therapeutic effects evaluation According to the reference articles 6,10,13,14 and the pathological characteristics of traumatic subdural effusion as well as its therapeutic effects, we evaluated the differences in GCS score, age structure, color and volume of effusions, protein concentration between the two treatment groups.According to the patients'records and telephone follow-up, we acquired the clinical presentations, recurrence situations and CT results of each patient. Based on aboved meterials, we classified the therapeutic effects into 3 groups(cured, improved and failed). The effective treated patients included cured and improved group. 3.Results:The effectiveness of the study group is much higher than that of the control group (The difference has statistical significance. Table 7). The patients in study group has shorter length of hospital stay. The effective rate and recurrence rate in study group are 97% and 3.8% respectively. In the control group, the effective rate and recurrence rate are 70% and 30%(The difference has statistical significance. P<0.05. Table 8). There were no infectious complications and tension pneumocephalus in either group.4.Conclusions:The patients'outcomes of the study group were much superior to that of the control group. The improved small bone slot drainage had simple procedures and evident effects, which made it a preferred treatment for progressive traumatic subdural effusion patients.
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