Clinical Study Of Standard Bone Flap Decompressive Craniotomy Combined With Drainage Of The Sylvian Fissures Cistern For Treatment Of Patients With Severe Traumatic Brain Injury

Traumatic brain injury is a common disease in neurosurgery and has attracted worldwide attention in recent years due to its huge economic losses.Treatment of traumatic brain injury patients consumed a lot of manpower and material resources,therefore the exploration of TBI care system has become a hot topic in neurosurgery.Standard bone flap decompressive craniotomy is a surgical method to effectively reduce intracranial pressure.The mortality rate of patients with severe traumatic brain injury has been greatly reduced,with the application of standard bone flap decompressive craniotomy surgery.Nevertheless,traumatic brain injury patients are still one of the highest types of trauma mortality,need to further improve the level of treatment urgently.Craniocerebral hemorrhage is often associated with subarachnoid hemorrhage,which is an independent risk factor leading to poor prognosis of patients,suggesting that treatment of subarachnoid hemorrhage can improve the prognosis of patients.Objective:In this study,A randomized controlled trials were conducted to explore the therapeutic effects of standard bone flap decompressive craniotomy combined with drainage of the sylvian fissures cistern on severe traumatic brain injury and to explore the Effect of drainage of the sylvian fissures cistern in lateral plication pool on postoperative cerebral vasospasm and hydrocephalus in patients with severe traumatic brain injury.In order to reduce the mortality of patients with severe traumatic brain injury,improve the prognosis of patients and provide the best therapy for patients with severe traumatic brain injury.Methods:Patients admitted to our hospital who meet the criteria for severe traumatic brain injury and need to undergo unilateral frontal dome standard decompression of large bone flap are divided into experimental group and control group according to whether dissecting the sylvian fissures cistern and placing drainage in the operation.Patients in the control group were treated with standard large bone flap decompression.Patients in the experimental group dissect the sylvian fissures cistern during the standard decompressive craniotomy,and placed a multi-lateral subdural drainage tube at the lateral fissure.The drainage tube was removed approximately 7 days after surgery.All patients underwent transcranial Doppler ultrasound on the 3rd,5th,7th,10 th,and 14 th days after operation.Record arterial blood flow velocity and blood flow of the middle cerebral artery on both sides combined with the patient’s symptoms and signs to determine whether cerebral vasospasm exists.GOS scores and postoperative complications such as hydrocephalus and intracranial infection were collected at 6 months after injury in both groups.The prognostic analysis of two groups of patients was based on rank sum test of rank data.Post-surgical cerebrovascular spasm,hydrocephalus,and intracranial infection rates were compared between groups using chi-square test,P<0.05 was considered statistically significant.Results:1.A total of 152 valid cases were collected,74 in the experimental group and 78 in the control group.Statistics of prognosis show that: There was no significant difference in mortality between the two groups,with a mortality rate of 28.3%.The long-term neurological prognosis in the surviving patients in experimental group was better than that in the control group,and the difference was statistically significant.2.The incidence of postoperative cerebral vasospasm and hydrocephalus between the two groups was statistically significant,while there was no significant difference in the incidence of intracranial infection.Conclusion:1.Standard bone flap decompressive craniotomy combined with drainage of the sylvian fissures cistern cannot significantly reduce mortality in patients with severe traumatic brain injury,but can significantly improve neurological function in surviving patients.2.The drainage of sylvian fissures cistern in lateral plication pool can significantly reduce the incidence of postoperative cerebral vasospasm and hydrocephalus in patients with severe traumatic brain injury and does not increase the incidence of intracranial infection.