Effect of hyperbaric oxygen on the incidence of complications following decompressive cranioectomy in severe traumatic brain injury

Abstract

Objective To explore the effects of hyperbaric oxygen (HBO) on the incidence of complications and treatment efficacy following decompressive craniectomy(DC)in severe traumatic brain injury. Methods A total of 160 patients who underwent DC for severe traumatic brain injury from January 2010 to December 2014 in the Neurosurgery Department of Yantai Yuhuangding Hospital were chosen for the study. The subjects were divided into the HBO group(86 Patients) and the routine treatment group(74 patients) in accordance with different treatment methods. Incidence of complications, changes in EEG at different time points after surgery, the levels of transforming factor-β1 (TGF-β1)and myelin basic protein (MBP) in cerebrospinal fluid, scores of Glasgow Coma Scale as well as scores of Modified Rankin Scale 6 months after surgery were compared between the two groups. Results Following DC in severe traumatic brain injury, the rates of cerebral herniation(31.4%), postsurgical epilepsy(10.5%)and hydrocrania(11.6%)in the HBO group were all obviously decreased(47.3%, 23.0%, 24.3%), as compared with those of the control group, and statistical significance could be seen, when comparisons were made between the 2 groups (P 0.05). In the HBO group, the levels of TGF-β 1 and MBP in the cerebrospinal fluid 14 and 21 days after surgery were significantly decreased, as compared with those of the routine treatment group. The EEG and GCS scores in the HBO group were significantly improved, 1 and 3 months after surgery, as compared with those of the routine treatment group. The scores of the modified Rankin Scale of the HBO group, which were obtained 6 months after surgery, were significantly higher than those of the routine treatment group, and statistical significance could be noted, when comparisons were made between the 2 groups (P<0.05). Conclusions Following decompressive cranioectomyin, HBO in the treatment of severe traumatic brain injury could obviously decrease the rates of cerebral herniation, postsurgical epilepsy and hydrocrania. HBO could also substantially improve EEG and decrease levels of TGF-β 1 and MBP, 14 and 21 days after surgery, and improve the prognosis of the patients. Key words: Severe traumatic brain injury; Decompressive craniectomy; Hyperbaric oxygen; Cerebral herniation; Postsurgical epilepsy; Subdural effusion; Hydrocrania; Transforming factor-β1; Myelin basic protein