Comparative Study Of Craniotomy Hematoma Removal And Minimally Invasive Borehole Drainage For Hypertensive Cerebral Hemorrhage

Objective:To compare the levels of serum tumor necrosis factor alpha?TNF-??,S100?,neuron specific enolase?NSE?and Glasgow Coma Scale?GCS?in patients with hypertensive intracerebral hemorrhage after craniotomy and drainage and to study the effects of two methods on brain injury.Methods:46 cases of hypertensive cerebral hemorrhage that were treated by neurosurgery from July 2016 to July 2017 in The First Hospital of Shanxi Medical University were divided into drilling group?22 cases?and craniotomy group?24 cases?.The control group were 20 healthy persons for physical examination in the same period.The serum levels of TNF-?,S100?,NSE and GCS score were measured at 1^st,3^rd,7^th and 14^th days after operation in the drilling and craniotomy groups,and the serum levels of TNF-?,S100?,NSE in the control group were measured.The serum levels of TNF-?,S100?,NSE and GCS score were compared between the drilling group and the craniotomy group at 1^st,3^rd,7^th and 14^th days after operation and the control group.Results:The serum TNF-?,S100?,NSE in the drilling group and the craniotomy group were higher than the normal level at the early postoperative period,and they both peaked at the beginning and then gradually decreased?TNF-?:F=38.629,P=0.000;S100?:F=33.381,P=0.000;NSE:F=25.619,P=0.000?.The GCS scores of the 2groups were lower on the 1^st to 7^th days after operation,and they both increased on the14^th day after operation and were still lower than normal levels?F=11.569,P=0.000?.At 1^st,3^rd,7^th and 14^th days after operation serum TNF-?in the drilling group and the craniotomy group were not sta-tistically different(1^st d:?²=1.149,P=0.563;3^rd d:?²=0.440,P=0.802;7^th d:Hc=3.555,P=0.169;14^th d:Hc=1.219,P=0.544).At1^st,3^rd,7^th and 14^th days after operation serum S100?in the drilling group and the craniotomy group were not statistically different(1^st d:?²=0.087,P=0.957;3^rd d:?²=0.156,P=0.925;7^th d:Hc=0.826,P=0.662;14^th d:Hc=0.485,P=0.785).At1^st,3^rd,7^th and 14^th days after operation serum NSE in the drilling group and the craniotomy group were not statistically different(1^st d:?²=0.051,P=0.975;3^rd d:Hc=4.450,P=0.108;7^th d:Hc=2.754,P=0.252;14^th d:Hc=2.031,P=0.362).At1^st,3^rd,7^th and 14^th days after operation GCS scores in the drilling group and the craniotomy group were not statistically different(1^st d:?²=0.080,P=0.961;3^rd d:?²=0.253,P=0.881;7^th d:?²=0.793,P=0.673;14^th d:?²=0.076,P=0.962).Conclusion:There was no difference in the effects of craniotomy and drainage on serum brain injury factors such as TNF-?,S100?,NSE and GCS scores in patients with moderate to large amounts of hypertensive intracerebral hemorrhage.Craniotomy hematoma removal can not easily be considered less effective than drilling and drainage,and two kinds of surgery have their own advantages and disadvantages.Clinical applications need to be flexible according to different situations.