Technique of Stepwise Intracranial Decompression Combined with External Ventricular Drainage Catheters Improves the Prognosis of Acute Post-Traumatic Cerebral Hemispheric Brain Swelling Patients.
BACKGROUND
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.


METHODS
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).


RESULTS
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).


CONCLUSIONS
Our data suggest that S-SLTC + EVD is more effective for controlling ICP, improving neurological outcome, and decreasing mortality rate compared with routine SLTC.
Department of Neurosurgery, The First People's Hospital of Kunshan Affiliated with Jiangsu University , Suzhou , China.
Lei
L
Shi
Department of Neurosurgery, Fourth Affiliated Yancheng Hospital of Nantong University , Yancheng , China.
Guan
G
Sun
Department of Neurosurgery, Nanjing Medical University Affiliated Nanjing Brain Hospital , Nanjing , China.
Chunfa
C
Qian
Department of Neurosurgery, The First People's Hospital of Kunshan Affiliated with Jiangsu University , Suzhou , China.
Tianhong
T
Pan
Department of Neurosurgery, The First People's Hospital of Kunshan Affiliated with Jiangsu University , Suzhou , China.
Xiaoliang
X
Li
Department of Neurosurgery, The First People's Hospital of Kunshan Affiliated with Jiangsu University , Suzhou , China.
Shuguang
S
Zhang
Department of Neurosurgery, Suzhou Kowloon Hospital Affiliated with Shanghai Jiao Tong University School of Medicine , Suzhou , China.
Zhimin
Z
Wang
GOS Score; external ventricular drainage; hemispheric brain swelling; severe traumatic brain injury; stepwise intracranial decompression