Analysis Of Bilateral Craniotomy For Treatment Of Severe Traumatic Brain Injury

Objective: The aim of this research was to explore the efficacy of bilateral decompressive craniectomy in treatment ofpost-traumatic acute diffuse brain swellings caused by severe traumatic injury,find the optimal surgical approach and the prevention of postoperative complications.It would provide clinical and theoretical basis of post-traumatic acute diffuse brain swellings caused by severe traumatic injury.What's more,the research may improve the survival rate,and reduce the mortality and disability of patients.Methods: We retrospectively analyzedpatients with severe traumatic injury at department of neurosurgery in First Affiliated Hospital(Yijishan Hospital)of Wan Nan Medical College between June 2013 and June 2015.Survey Method of this reseach is divided into 3 parts:1.Count the number of the patients received bilateral decompressive craniotomy and unilateral standard large trauma craniotomy;2.Investigate the clinical data of patients through telephone follow-up,outpatient and inpatient follow-up,home visits,etc.Then evaluate the efficacy of treatment according to the Glasgow outcome score system;3.The outcomes of treatment using the two surgical methods and the prevention of complications were used as observation indexes for therapeutic efficacy.The data was based on the follow-up information and clinical experience.Results: 87 patients with post-traumatic acute diffuse brain swellings caused by severe traumatic injury was analyzed in this study,including 35 cases of bilateral decompressive craniectomy and 52 cases of unilateral standard large trauma craniotomy.The follow-up carried on 6 months after operation showed that,in patients received bilateral decompressive craniectomy,12 cases of patients recovered well(mild disability),moderate disability in 10 cases,severe disability in 5 cases,plant survival in 6 cases and death in 2 cases;andin patients received unilateral standard large trauma craniotomy,2 cases recovered well(mild disability),moderate disability in 10 cases,severe disability in 12 cases,plant survival in 8 cases and 13 cases died.Conclusions: 1.For patients with diffuse brain swelling caused by severe traumatic injury the results showed that the efficacy of bilateral decompressive craniectomy was better than unilateral standard large trauma craniotomy,patients received bilateral decompressive craniectomy had better overall survival.2.Although the incidence of cerebrospinal fluid leakage,the occurrence of intracranial infection couldn't be reduced by receivingbilateral decompressive craniectomy,the incidence of intraoperative encephalocele and postoperative incisional hernia were lower than the group receivedunilateral standard large craniectomy.