Characteristics of diagnosis and treatments of postoperative subdural effusion of craniocerebral traumaic decompressive craniectomy

Abstract

Objective To investigate the causes and characteristics of postoperative subdural effusion(pSE) of craniocerebral traumaic decompressive craniectomy. Methods The clinical data of 90 patients with pSE of craniocerebral traumaic decompressive craniectomy from July 2008 to May 2015 were retrospectively analyzed. Correlation factors of pSE formation were analyzed according to postoperative CT the pSE formation sites were classified and the characteristics of each type were summarized. Results Among the 90 cases, 78 cases(86.7%) of cephalocele, 44 cases(56.4%) of pSE; 82 cases(91.1%) of tSAH in grade Ⅱ-Ⅳ, 54 cases(65.8%) of pSE. The more severe of cephaloceles and tSAH, the higher the incidence of pSE was. According to CT, pSE was divided into four types, there was 12 cases(13.3%) of skull window type, 19 casess(21.1%) of longitudinal fissure type, 27 cases(30.0%) of contralateral type and 32 cases(35.6%) of mixed type. The curative effects of different treatments on pSE were different. The formation mechanisms of mixed type pSE was complex, the curative effect with single therapy was poor, the variety of methods executed step-by-step to improve the cure rate was need. Conclusions pSE is caused by abnormal circulation dynamics and pathway of the cerebrospinal fluid. The degree of postoperative cephalocele is the main factor of skull window type pSE, and the degree of postoperative tSAH is the direct factor of longitudinal fissure type pSE and contralateral type pSE. The bigger skull deletion, the more severe postoperative encephalocele and tSAH, the higher probability for the formation of mixed type pSE. According to the different types of pSE, relative treatment strategies are developed to improve the clinical curative effect. Key words: Craniocerebral trauma; Decompressive craniectomy; Subdural effusion