Abstract
Acute post-traumatic cerebral hemispheric brain swelling (ACHS) is a serious disorder that occurs after traumatic brain injury, and it often requires immediate treatment. The aim of our clinical study was to assess the effects of stepwise intracranial decompression combined with external ventricular drainage (EVD) catheters on the prognosis of ACHS patients. A retrospective study was performed on 172 cases of severe craniocerebral trauma patients with ACHS. The patients were divided into two groups: unilateral stepwise standard large trauma craniectomy (S-SLTC) combined with EVD catheter implants (n = 86) and unilateral routine frontal temporal parietal SLTC (control group, n = 86). No significant differences in age, sex, or pre-operative Glasgow Coma Scale score were observed between groups (P < 0.05). There were no significant differences in the ipsilateral subdural effusion incidence rates between the S-SLTC + EVD treatment group and the routine SLTC group. However, the incidence rates of intraoperative acute encephalocele and contralateral epidural and subdural hematoma in the S-SLTC + EVD group were significantly lower than those in the SLTC group (17.4 and 3.5 vs. 37.2 and 23.3%, respectively). The mean intracranial pressure (ICP) values of patients in the S-SLTC + EVD group were also lower than those in the SLTC group at days 1 through 7 (P < 0.05). A positive neurological outcome [Glasgow Outcome Scale (GOS) score 4-5, 50.0%] and decreased mortality (15.1%) was observed in the S-SLTC + EVD group compared to the neurological outcome (GOS score 4-5, 33.8%; 36.0%) in the SLTC group (P < 0.05). Our data suggest that S-SLTC + EVD is more effective for controlling ICP, improving neurological outcome, and decreasing mortality rate compared with routine SLTC.
Highlights
Acute craniocerebral trauma is a severe clinical condition that commonly occurs in trauma patients
Our data suggest that S-standard large trauma craniectomy (SLTC) + external ventricular drainage (EVD) is more effective for controlling intracranial pressure (ICP), improving neurological outcome, and decreasing mortality rate compared with routine SLTC
Severe traumatic brain injury (STBI) leads to extensive brain tissue contusion and secondary brain injury, which is characterized by brain tissue volume expansion and severe cerebral edema that results in intractable intracranial hypertension
Summary
Acute craniocerebral trauma is a severe clinical condition that commonly occurs in trauma patients. Brain edema and swelling often occur during traumatic brain injuries. Severe traumatic brain injury (STBI), defined as a head trauma that is associated with a Glasgow Coma Scale (GCS) score of 3–8, leads to increased mortality and morbidity and poses a major problem in critical care medicine (Teasdale and Jennett, 1974). Post-traumatic acute brain swelling (PABS) is a severe complication that can occur after STBI. PABS is usually divided into two types based on the results of the CT image: acute generalized brain swelling (AGBS) and acute post-traumatic cerebral hemispheric brain swelling (ACHS). Acute post-traumatic cerebral hemispheric brain swelling (ACHS) is a serious disorder that occurs after traumatic brain injury, and it often requires immediate treatment. The aim of our clinical study was to assess the effects of stepwise intracranial decompression combined with external ventricular drainage (EVD) catheters on the prognosis of ACHS patients
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