Clinical Analysis Of The External Cerebral Herniation,Expansion Of Hemorrhagic Contusions,Cerebral Infarction After Decompressive Craniectomy For Traumatic Brain Injury

Objective:This study is to explore the relationship between some factors and prognosis on patients with traumatic brain injury (TBI) who underwent decompressive craniectomy (DC).These factors analysed contain external cerebral herniation (Herniation formed by expansion of brain tissue protruding skull defect), expansion of intracranial hematoma or/and brain contusion and cerebral infarction.Method:48 patients with TBI who underwent DC were analyzed in the retrospective study. The thickness of external cerebral herniation were measured at different post-operative time (after third day, first week, second week, first month and second month).The expansion volumes of hemorrhagic contusion were also measured.The incidence rate of cerebral infarction, preoperative GCS score and 6-month GOS score were recorded. All the data were analyzed with SPSS 13.0.Result:(1)In all the 48 patients with TBI who underwent DC,5 cases died(10.4%); 8 cases of long-term coma or plant survival(16.7%), 19 cases of severe disability (39.5%);8 patients of moderate disability (16.7%);8cases of good recovery(16.7%).(2) The thickness of external cerebral herniation at different post-operative times:after third day, 0.935cm±0.144cm;after first week,0.995cm±0.126cm;after second week,1.501cm±0.125cm;after first month,1.113cm±0.116cm;after second month,1.244cm±0.163cm.There were significant difference in the thickness between these times (P=0.008<0.05),especially the second postoperative week, but no significant difference between the others.The external cerebral herniation was more likely to appear in the group with lower GCS score (P=0.047<0.05).Though the incidence rate of external cerebral herniation was lower in GOS 4-5(75%)than GOS 1-2 (92.3%),the difference was not statistically significant (P=0.162> 0.05),which maybe related to the less cases in this group.(3)Expansion of intracranial hematoma or brain contusion after DC appeared on 28 cases, consists of 6 caess with new epidural hematoma,16 caess with expansion of brain hematoma or/and contusion and 6 caess with new epidural hematoma plus expansion of brain hematoma or/and contusion. The differences were not statistically significant in incidence rate of expansion of intracranial hematoma or brain contusion between different GOS groups (P=0.182> 0.05).(4) The incidence rate of cerebral infarction on TBI patients after DC was 12.5%.5 cases occurred in posterior cerebral artery, and 1 case occurred in middle cerebral artery. Although the incidence rate of cerebral infarction was higher in GCS 3-5 (23.1%)than the others(GCS 6-8,8%; GCS>8,10%),but the differences were also not statistically significant (P=0.398> 0.05).(5) The differences were statistically significant in incidence rate of cerebral infarction between different GOS groups (P=0.048<0.05).The higher incidence, the poorer prognosis.Conclusion:The incidence rate of external cerebral herniation on TBI patients after DC was 77%.There were significant difference in the thickness of external cerebral herniation between the second week after decompressive craniectomy and the others (after third day, first week, first month and second month), but no significant difference between the others.It indicates that the thickness of external cerebral herniation has a process of initial increasing and then decreasing after the second week. In addition, The external cerebral herniation was more likely to appear in the group with lower GCS score.The incidence rate of cerebral infarction on TBI patients after DC was 12.5%,while the average volumes was 40.8±35ml.The incidence rate of cerebral infarction after decompressive craniectomy may indicates poor prognosis, but there were no significant correlation between the incidence rate of cerebral infarction and the GCS score.The incidence rate of Expansion of intracranial hematoma or/and brain contusion on TBI patients after DC was 58.3%,while the average volumes was 48.8±42.1ml.Prognosis did not correlate with the incidence rate of brain contusion expansion or new intracranial hematoma after decompressive craniectomy, but with the volumes of the hematoma.