Woertgen Chris, Rothoerl Ralf Dirk, Schebesch Karl Michael, Albert Ruth
Department of Neurosurgery, University of Regensburg, Franz-Josef-Strass-Allee 11, 93042 Regensburg, Germany.
J Clin Neurosci. 2006 Aug;13(7):718-21. doi: 10.1016/j.jocn.2005.08.019. Epub 2006 Aug 14.
Despite the increasing acceptance of craniectomy in patients with traumatic brain injury, the value of early decompressive craniectomy in patients with acute subdural haematoma is still under debate. In this retrospective study, we reviewed 180 patients with traumatic acute subdural haematoma, 111 of whom were treated with haematoma evacuation via craniotomy and 69 of whom were treated with early decompressive craniectomy. Due to the higher incidence of signs of herniation for patients in the craniectomy group, the mortality rate in this group was higher than that in the craniotomy group (53% vs. 32.3%). However, overall there was no significant difference in outcome between the two groups. Age and clinical signs of herniation were significantly associated with an unfavourable outcome, regardless of the type of surgery. Decompressive craniectomy did not seem to have a therapeutic advantage over craniotomy in traumatic acute subdural haematoma.
尽管开颅减压术在创伤性脑损伤患者中的接受度日益提高，但早期减压性开颅术在急性硬膜下血肿患者中的价值仍存在争议。在这项回顾性研究中，我们回顾了180例创伤性急性硬膜下血肿患者，其中111例接受了开颅血肿清除术，69例接受了早期减压性开颅术。由于开颅减压术组患者出现脑疝体征的发生率较高，该组的死亡率高于开颅术组（53%对32.3%）。然而，总体而言，两组的预后没有显著差异。无论手术类型如何，年龄和脑疝的临床体征与不良预后显著相关。在创伤性急性硬膜下血肿中，减压性开颅术似乎并不比开颅术具有治疗优势。
