Yi Wan1, Lei Shi2, Zhimin Wang3, Guan Sun4, Tianhong Pan5, Shuguang Zhang5, Yanjun Zeng6. 1. Department of Neurosurgery, Suzhou Kowloon Hospital affiliated with Shanghai Jiao Tong University School of Medicine, Suzhou, 215021, PR China. 2. Department of Neurosurgery, The First People's Hospital of Kunshan affiliated with Jiangsu University, Suzhou, 215300, PR China. Electronic address: sl1012002322@126.com. 3. Department of Neurosurgery, Suzhou Kowloon Hospital affiliated with Shanghai Jiao Tong University School of Medicine, Suzhou, 215021, PR China. Electronic address: wanyiwzm@126.com. 4. Department of Neurosurgery, Fourth Affiliated Yancheng Hospital of Nantong University, Yancheng, 224000, PR China. 5. Department of Neurosurgery, The First People's Hospital of Kunshan affiliated with Jiangsu University, Suzhou, 215300, PR China. 6. Biomechanics and Medical Information Institute, Beijing University of Technology, Beijing 100022, PR China. Electronic address: yjzeng@bjut.edu.cn.
Abstract
OBJECTIVE: This study aimed to introduce an effective treatment for intractable contralateral subdural effusion after standard decompressive craniectomy in patients with severe traumatic brain injury (TBI) and to analyze the underlying mechanism. METHODS: A retrospective analysis was performed in 13 patients with severe traumatic craniocerebral injury showing complicated intractable contralateral subdural effusion after standard decompressive craniectomy, in whom satisfactory results were not obtained from treatments, including compression bandaging, head-down bed rest (HDBR), continuing lumbar drainage, and Ommaya catheter drainage. Among these patients, 6 underwent temporal muscle sticking, while 7 underwent early cranioplasty. The postoperative changes in the subdural effusion were observed. RESULTS: In the 6 patients who underwent temporal muscle sticking and the 7 who underwent early cranioplasty, the subdural effusion completely resolved or was significantly reduced within one month, and no recurrence was observed in the 6-month follow-up period. However, secondary bilateral cranioplasty was still necessary in the postoperative 3-6 months for the patients who underwent temporal muscle sticking. In the early cranioplasty group, there were three total operations, and the average length of stay (ALOS) was 76days. In the temporal muscle sticking group, there were four total operations, and the ALOS was 56.1days. A retrospective analysis of surgical pain showed that 100% of the patients in the first group experienced unacceptable suffering, while 14.3% of the patients in the second group experienced pain. CONCLUSION: Early cranioplasty is an effective, economical, and less painful treatment for intractable contralateral subdural effusion after standard decompressive craniectomy.
OBJECTIVE: This study aimed to introduce an effective treatment for intractable contralateral subdural effusion after standard decompressive craniectomy in patients with severe traumatic brain injury (TBI) and to analyze the underlying mechanism. METHODS: A retrospective analysis was performed in 13 patients with severe traumatic craniocerebral injury showing complicated intractable contralateral subdural effusion after standard decompressive craniectomy, in whom satisfactory results were not obtained from treatments, including compression bandaging, head-down bed rest (HDBR), continuing lumbar drainage, and Ommaya catheter drainage. Among these patients, 6 underwent temporal muscle sticking, while 7 underwent early cranioplasty. The postoperative changes in the subdural effusion were observed. RESULTS: In the 6 patients who underwent temporal muscle sticking and the 7 who underwent early cranioplasty, the subdural effusion completely resolved or was significantly reduced within one month, and no recurrence was observed in the 6-month follow-up period. However, secondary bilateral cranioplasty was still necessary in the postoperative 3-6 months for the patients who underwent temporal muscle sticking. In the early cranioplasty group, there were three total operations, and the average length of stay (ALOS) was 76days. In the temporal muscle sticking group, there were four total operations, and the ALOS was 56.1days. A retrospective analysis of surgical pain showed that 100% of the patients in the first group experienced unacceptable suffering, while 14.3% of the patients in the second group experienced pain. CONCLUSION: Early cranioplasty is an effective, economical, and less painful treatment for intractable contralateral subdural effusion after standard decompressive craniectomy.
Authors: Igor Paredes; José Antonio F Alén; Ana María Castaño-León; Pedro-Antonio Gómez; Luis Jimenez-Roldán; Irene Panero; Carla Eiriz; Daniel García-Perez; Luis Miguel Moreno; Olga Esteban-Sinovas; Pedro Gonzalez-León; Ángel Perez-Nuñez; Pablo M Munarriz; Alfonso Lagares de Toledo; Alfonso Lagares Journal: Neurosurg Rev Date: 2021-10-09 Impact factor: 3.042