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

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. Key words: Epidural hematoma; Subdural hematoma; Brain hernia; Burr-hole; Craniotomy