Clinical Study On The Effect Of Cisternostomy And Controlled Drainage On Intracranial Pressure After Severe Traumatic Brain Injuries

Objective: To study the effect on reducing intracranial pressure(ICP)by cisternostomy and controlled drainage that cerebrospinal fluid in prepontine cistern in patients with severe traumatic brain injury.To improve the decompression effect of craniotomy for severe traumatic brain injury and to Reduce secondary injury,so as to provide a clinical basis for clinical treatment and surgical methods.Methods: Patients with severe traumatic brain injury(s TBI)admitted to the department of neurosurgery of the Shanxi Dayi hospital Affiliated to Shanxi Medical university from September 2016 to June 2018 were selected as the research objects.According to the random number table method,the patients who needed to undergo decompression were divided into group A(standard decompression group),group B(decompression with the cisternostomy group),group C(decompression with the cisternostomy and drainage group).The patients were treated with ventricular intracranial pressure monitoring probe before craniotomy.After decompression was performed in the group A and the group C that places a drainage tube.Intracranial pressure(ICP)numerical at 2h,6h,12 h and 1,3,5 days after surgery were recorded for 3 groups of patients respectively,and the ICP trends of each group were compared.Head CT was reexamined 48 hours after surgery,and the difference in Rotterdam CT score before and after surgery between each group was compared.The patients were followed up visit for 6 months.According to Glasgow Outcome Scale(GOS)to analyze the effect of cisternostomy and external drainage on prognosis.All patients roughly got the same treatment after surgery.SPSS22.0 statistical software was used to describe and analyze the above indicators.Results: The average ICP(mm Hg)values of all the major time points in group A were respectively: 13.66±8.76?16.28±7.09?17.30±6.98?19.48±2.47?20.33±2.50?17.95±2.66.The average ICP(mm Hg)of group B were: 9.23±2.60?10.33±2.09?10.81±2.94?13.97±2.40?15.04±3.40?14.27±1.93.group C were: 5.58±1.42?7.05±1.82?8.27±1.94?11.44±1.92?10.78±1.89?10.75±2.05.The differences at each time point were statistically significant(P<0.05).The interaction between time and group was not statistically significant(P>0.05).The differences between the groups were statistically significant(P<0.05).Multiple comparisons are shown that The ICP of group B was significantly lower than that of group A(P<0.05).The ICP of group C was significantly lower than that of group A and B(P<0.05),and the ICP of group C recovered stably.There was no significant difference in preoperative Rotterdam CT score between 3 groups(P>0.05).The improvement of postoperative CT score in the group C was statistically significant compared with group A(P<0.05).GOS score of 3 groups was compared which has not statistically significan.Conclusions: 1.Cisternostomy is an effective surgical treatment to reduce intracranial pressure.2.Cisternostomy and drainage of cerebrospinal fluid in the prepontine cistern which is helpful for the control of early intracranial pressure.3.Cisternostomy combined with anterior cistern drainage can accelerate the clearance of hemorrhagic cerebrospinal fluid and reduce secondary injury.