title: Effective treatment via early cranioplasty for intractable contralateral subdural effusion after standard decompressive craniectomy in patients with severe traumatic brain injury.
abstract: OBJECTIVE
  This study aimed to introduce an effective treatment for intractable contralateral subdural effusion after standard decompressive craniectomy in patients with severe traumatic brain injury (TBI) and to analyze the underlying mechanism.
  
  
  METHODS
  A retrospective analysis was performed in 13 patients with severe traumatic craniocerebral injury showing complicated intractable contralateral subdural effusion after standard decompressive craniectomy, in whom satisfactory results were not obtained from treatments, including compression bandaging, head-down bed rest (HDBR), continuing lumbar drainage, and Ommaya catheter drainage. Among these patients, 6 underwent temporal muscle sticking, while 7 underwent early cranioplasty. The postoperative changes in the subdural effusion were observed.
  
  
  RESULTS
  In the 6 patients who underwent temporal muscle sticking and the 7 who underwent early cranioplasty, the subdural effusion completely resolved or was significantly reduced within one month, and no recurrence was observed in the 6-month follow-up period. However, secondary bilateral cranioplasty was still necessary in the postoperative 3-6 months for the patients who underwent temporal muscle sticking. In the early cranioplasty group, there were three total operations, and the average length of stay (ALOS) was 76days. In the temporal muscle sticking group, there were four total operations, and the ALOS was 56.1days. A retrospective analysis of surgical pain showed that 100% of the patients in the first group experienced unacceptable suffering, while 14.3% of the patients in the second group experienced pain.
  
  
  CONCLUSIONS
  Early cranioplasty is an effective, economical, and less painful treatment for intractable contralateral subdural effusion after standard decompressive craniectomy.
authors: Department of Neurosurgery, Suzhou Kowloon Hospital affiliated with Shanghai Jiao Tong University School of Medicine, Suzhou, 215021, PR China.
authors: Yi
authors: Y
authors: Wan
authors: Department of Neurosurgery, The First People's Hospital of Kunshan affiliated with Jiangsu University, Suzhou, 215300, PR China. Electronic address: sl1012002322@126.com.
authors: Lei
authors: L
authors: Shi
authors: Department of Neurosurgery, Suzhou Kowloon Hospital affiliated with Shanghai Jiao Tong University School of Medicine, Suzhou, 215021, PR China. Electronic address: wanyiwzm@126.com.
authors: Zhimin
authors: Z
authors: Wang
authors: Department of Neurosurgery, Fourth Affiliated Yancheng Hospital of Nantong University, Yancheng, 224000, PR China.
authors: Guan
authors: G
authors: Sun
authors: Department of Neurosurgery, The First People's Hospital of Kunshan affiliated with Jiangsu University, Suzhou, 215300, PR China.
authors: Tianhong
authors: T
authors: Pan
authors: Department of Neurosurgery, The First People's Hospital of Kunshan affiliated with Jiangsu University, Suzhou, 215300, PR China.
authors: Shuguang
authors: S
authors: Zhang
authors: Biomechanics and Medical Information Institute, Beijing University of Technology, Beijing 100022, PR China. Electronic address: yjzeng@bjut.edu.cn.
authors: Yanjun
authors: Y
authors: Zeng
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000150:complications*; D003399:Craniotomy / Q000379:methods*; D056424:Decompressive Craniectomy / Q000379:methods; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013353:Subdural Effusion / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*
keywords: Cranioplasty; GOS score; Intractable contralateral subdural effusion; Severe traumatic brain injury; Standard decompressive craniectomy