Large M-shaped craniotomy combined with lobectomy for secondary decompression in patients following severe craniocerebral trauma: a single center retrospective study
10.3760/cma.j.issn.1671-8925.2018.06.007
- VernacularTitle:额颞枕M型超大骨瓣联合内减压术在颅脑损伤后接受二次减压患者中的应用
- Author:
Wei HUANG
1
;
Wenhao WANG
;
Hong LIN
;
Fei LUO
;
Junming LIN
;
Jun LI
;
Yuan ZHANG
;
Lianshui HU
;
Jianxian ZHENG
Author Information
1. 363000 漳州,解放军第一七五医院暨厦门大学附属东南医院神经外科,南京军区创伤神经外科中心
- Keywords:
Craniocerebral trauma;
Large M-shaped craniotomy combined with lobectomy;
Frontotemporal lobectomy
- From:
Chinese Journal of Neuromedicine
2018;17(6):575-581
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the clinical efficacy of large M-shaped craniotomy combined with lobectomy for secondary decompression in patients following severe craniocerebral trauma.Methods The clinical data were retrospectively analyzed of the 76 patients who had undergone secondary decompression following severe craniocerebral trauma from January 2007 to January 2010.The preoperative intracranial pressure (ICP) was 30～40 mmHg in 40 cases and ＞40 mmHg in 36 ones.All the patients received regular lobectomy in primary craniotomy;for secondary decompression some received simple lobectomy and some large M-shaped craniotomy combined with lobectomy.The patients undergoing different surgical procedures were compared in terms of survival rate,changes in intracranial pressure and therapeutic efficacy by the GOS 6 months post-discharge.Results Of the patients with 30～40 mmHg ICP,22 underwent large M-shaped craniotomy combined with lobectomy and 18 simple lobectomy.The survival rate within 7 days after surgery for the former patients (72.7％) was significantly higher than that for the latter ones (38.9％) (P＜0.05).Of the patients with ＞40 mmHg ICP,19 underwent large M-shaped craniotomy combined with lobectomy and 17 simple lobectomy,but all of them died within 7 days after surgery.Of those surviving the secondary decompression,7 received simple lobectomy and 16 large M-shaped craniotomy combined with lobectomy.The ICP in the latter patients was significantly lower at postoperative one day and 3 weeks than that in the former ones (P＜0.05).Compared with those receiving simple lobectomy,the patients receiving combined procedures had significantly higher GOS and significantly better prognosis (P＜0.05).There were no significant differences between the patients receiving two different surgical procedures in such adverse events as traumatic epilepsy,cerebrospinal fluid leakage,softening brain tissue,or wound malunion (P＞0.05).Conclusion For the patients with craniocerebral trauma who still suffer severe brain swelling or infarction after primary decompression,if their ICP is below 40 mmHg,large M-shaped craniotomy combined with lobectomy for secondary decompression can obviously decrease their ICP,increase their survival rate and improve their prognosis compared with simple lobectomy.
