Decompressive craniectomy versus reduction of boneflap in severe craniocerebral trauma surgery

  Objective  To investigate the whether bone flap should be remained in craniotomy of severe traumatic brain injury patients.

  Methods  The clinical data of 60 patients with severe craniocerebral trauma was retrospectively analyzed. All patients had a preoperative Glasgow Coma scale (GCS) score ≥ 8, unilateral cerebral contusion and subdural hematoma, and underwent unilateral craniotomy. Thirty patients with intraoperative bone flap reduction were included in bone flap reduction group, and 30 patients with intraoperative bone flap decompression were included in decompressive craniectomy group, and the prognosis and occurrence of complications of the two groups were compared.

  Results  At 6 months after injury, there was no significant difference in Glasgow Outcome Scale (GOS) score between two groups (P>0.05). After operation, the incidence of cerebral ischemia, edema and epilepsy in the bone flap reduction group was lower than that in the decompressive craniectomy group (P < 0.05).

  Conclusion  For unilateral cerebral contusion, subdural hematoma after unilateral surgical operation of craniocerebral trauma patients, clinical doctors should decide to select decompressive craniectomy or bone flap reduction according to patients'preoperative GCS score, presence of cerebral hernia, preoperative intracranial pressure, intraoperative specific circumstances, and avoid to remove bone flap blindly in order to reduce the occurrence of postoperative complications and improve patients'quality of life.