J Neurosurg. 2018 Oct;129(4):1017-1023. doi: 10.3171/2017.4.JNS152954. Epub 2017 Nov 17.
Decompressive craniectomy (DC) is a widely used procedure in neurosurgery; however, few studies focus on the best surgical technique for the procedure. The authors' objective was to conduct a prospective randomized controlled trial comparing 2 techniques for performing DC: with watertight duraplasty and without watertight duraplasty (rapid-closure DC).
The study population comprised patients ranging in age from 18 to 60 years who were admitted to the Neurotrauma Service of the Hospital da Restauração with a clinical indication for unilateral decompressive craniectomy. Patients were randomized by numbered envelopes into 2 groups: with watertight duraplasty (control group) and without watertight duraplasty (test group). After unilateral DC was completed, watertight duraplasty was performed in the control group, while in the test group, no watertight duraplasty was performed and the exposed parenchyma was covered with Surgicel and the remaining dura mater. Patients were then monitored daily from the date of surgery until hospital discharge or death. The primary end point was the incidence of surgical complications (CSF leak, wound infection, brain abscess, or subgaleal fluid collections). The following were analyzed as secondary end points: clinical outcome (analyzed using the Glasgow Outcome Scale [GOS]), surgical time, and hospital costs.
Fifty-eight patients were enrolled, 29 in each group. Three patients were excluded, leaving 27 in the test group and 28 in the control group. There were no significant differences between groups regarding age, Glasgow Coma Scale score at the time of surgery, GOS score, and number of postoperative follow-up days. There were 9 surgical complications (5 in the control group and 4 in the test group), with no significant differences between the groups. The mean surgical time in the control group was 132 minutes, while in the test group the average surgical time was 101 minutes, a difference of 31 minutes (p = 0.001). The mean reduction in total cost was $420.00 USD (a 23.4% reduction) per procedure in the test group.
Rapid-closure DC without watertight duraplasty is a safe procedure. It is not associated with a higher incidence of surgical complications (CSF leak, wound infection, brain abscess, or subgaleal fluid collections), and it decreased surgical time by 31 minutes on average. There was also a hospital cost reduction of $420.00 USD (23.4% reduction) per procedure. Clinical trial registration no.: NCT02594137 (clinicaltrials.gov).
去骨瓣减压术（DC）是神经外科中广泛应用的一种手术方法；然而，很少有研究关注该手术的最佳手术技术。作者的目的是进行一项前瞻性随机对照试验，比较两种 DC 手术技术：硬脑膜严密缝合组和不严密缝合组（快速闭合 DC）。
研究人群包括年龄在 18 至 60 岁之间的患者，这些患者因临床需要单侧去骨瓣减压术而被收入 Hospital da Restauração 的神经创伤科。患者通过编号信封被随机分为两组：硬脑膜严密缝合组（对照组）和不严密缝合组（试验组）。在完成单侧 DC 后，对照组进行硬脑膜严密缝合，而在试验组，不进行硬脑膜严密缝合，将暴露的脑实质用 Surgicel 覆盖，剩余的硬脑膜。然后，从手术日开始，每天监测患者直至出院或死亡。主要终点是手术并发症（CSF 漏、伤口感染、脑脓肿或皮下积液）的发生率。以下是次要终点：临床结果（采用格拉斯哥结局量表[GOS]分析）、手术时间和医院费用。
共纳入 58 例患者，每组 29 例。3 例患者被排除，试验组剩余 27 例，对照组剩余 28 例。两组在年龄、手术时格拉斯哥昏迷量表评分、GOS 评分和术后随访天数方面无显著差异。有 9 例手术并发症（对照组 5 例，试验组 4 例），两组间无显著差异。对照组的平均手术时间为 132 分钟，而试验组的平均手术时间为 101 分钟，相差 31 分钟（p = 0.001）。试验组每个手术的总费用平均降低 420.00 美元（降低 23.4%）。
不严密缝合的快速闭合 DC 是一种安全的手术方法。它与手术并发症（CSF 漏、伤口感染、脑脓肿或皮下积液）的发生率增加无关，并且平均缩短了 31 分钟的手术时间。每个手术的医院费用也降低了 420.00 美元（降低 23.4%）。临床试验注册号：NCT02594137（clinicaltrials.gov）。
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