Emergent burr hole drainage followed by decompressive craniotomy improves the clinical outcome of traumatic intracerebral haematoma-induced cerebral hernia

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Author:
HU Lian-shui(Department of Neurosurgery, 175th Hospital of Chinese PLA and Southeast Hospital Affiliated to Xiamen University, Zhangzhou 363000, China)
ZHANG Ming-sheng(Department of Neurosurgery, 175th Hospital of Chinese PLA and Southeast Hospital Affiliated to Xiamen University, Zhangzhou 363000, China)
WANG Wen-hao(Department of Neurosurgery, 175th Hospital of Chinese PLA and Southeast Hospital Affiliated to Xiamen University, Zhangzhou 363000, China)
YU Yi-gang(Department of Neurosurgery, 175th Hospital of Chinese PLA and Southeast Hospital Affiliated to Xiamen University, Zhangzhou 363000, China)
LIN Jun-ming(Department of Neurosurgery, 175th Hospital of Chinese PLA and Southeast Hospital Affiliated to Xiamen University, Zhangzhou 363000, China)
HUANG Wei(Department of Neurosurgery, 175th Hospital of Chinese PLA and Southeast Hospital Affiliated to Xiamen University, Zhangzhou 363000, China)
LUO Fei(Department of Neurosurgery, 175th Hospital of Chinese PLA and Southeast Hospital Affiliated to Xiamen University, Zhangzhou 363000, China)
ZHANG Yuan(Department of Neurosurgery, 175th Hospital of Chinese PLA and Southeast Hospital Affiliated to Xiamen University, Zhangzhou 363000, China)
ZHOU Long(Department of Neurosurgery, 175th Hospital of Chinese PLA and Southeast Hospital Affiliated to Xiamen University, Zhangzhou 363000, China)
Journal Title:
Chinese Journal of Neuromedicine
Issue:
Volume 11, Issue 09, 2012
DOI:
10.3760/cma.j.issn.1671-8925.2012.09.011
Key Word:
Epidural hematoma;Subdural hematoma;Brain hernia;Burr-hole;Craniotomy

Abstract: Objective To investigate the clinical benefits of emergent burr hole drainage in combination with decompressive craniotomy for patients with traumatic intracerebral haematoma-induced cerebral hernia. Methods A total of 291 patients with brain hernia caused by acute traumatic epidural and/or subdural hematoma were chosen in our study; 143 of them were treated with decompressive craniotomy alone (ordinary decompression group, admitted to our hospital from January 2003 to December 2006) and 148 of them were treated with emergent burr hole drainage in combination with decompressive craniotomy (emergent surgical intervention group,admitted to our hospital from January 2007 to June 2011).Clinical parameters,including Glasgow Outcome Scale (GOS) scores,incidence of massive cerebral infarction,pupil retraction rate,and Glasgow Coma Scale (GCS) scores,were evaluated retrospectively analyzed. Results Patients in ordinary decompression group had higher GOS scores than those in emergent surgical intervention group (Z=-4.012,P=0.000); mean rank indicated that the treatment efficacy in the emergent surgical intervention group was better than that in the other group.Patients in ordinary decompression group had significantly reduced incidence of massive cerebral infarction (45/148) as compared with patients in ordinary decompression group (70/143,P=0.000).Much more patients (124/148) enjoyed increment of GCS scores in the emergent surgical intervention group as compared with those in the ordinary decompression group (65/143,P=0.000). Conclusion Emergent burr hole drainage followed by decompressive craniotomy is an effective method in saving patients with brain hernia caused by acute traumatic intracerebral haematoma, which can notably resolve intracranial hypertension as soon as possible and give longer time for surgery,therefore,it can improve the prognosis.

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