Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Box 167, Cambridge, CB2 0QQ, UK.
NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK.
Acta Neurochir (Wien). 2021 May;163(5):1415-1422. doi: 10.1007/s00701-021-04783-6. Epub 2021 Mar 18.
Traumatic brain injury (TBI) and stroke have devastating consequences and are major global public health issues. For patients that require a cerebral decompression after suffering a TBI or stroke, a decompressive craniectomy (DC) is the most commonly performed operation. However, retrospective non-randomized studies suggest that a decompressive craniotomy (DCO; also known as hinge or floating craniotomy), where a bone flap is replaced but not rigidly fixed, has comparable outcomes to DC. The primary aim of this project was to understand the current extent of usage of DC and DCO for TBI and stroke worldwide.
A questionnaire was designed and disseminated globally via emailing lists and social media to practicing neurosurgeons between June and November 2019.
We received 208 responses from 60 countries [40 low- and middle-income countries (LMICs)]. DC is used more frequently than DCO, however, about one-quarter of respondents are using a DCO in more than 25% of their patients. The three top indications for a DCO were an acute subdural hematoma (ASDH) and a GCS of 9-12, ASDH with contusions and a GCS of 3-8, and ASDH with contusions and a GCS of 9-12. There were 8 DCO techniques used with the majority (60/125) loosely tying sutures to the bone flap. The majority (82%) stated that they were interested in collaborating on a randomized trial of DCO vs. DC.
Our results show that DCO is a procedure carried out for TBI and stroke, especially in LMICs, and most commonly for an ASDH. The majority of the respondents were interested in collaborating on a is a future randomized trial.
创伤性脑损伤（TBI）和中风具有破坏性的后果，是全球主要的公共卫生问题。对于因 TBI 或中风需要进行脑减压的患者，去骨瓣减压术（DC）是最常进行的手术。然而，回顾性非随机研究表明，减压性颅骨切开术（DCO；也称为铰链或浮动颅骨切开术），其中骨瓣被替换但不固定，与 DC 具有可比的结果。本项目的主要目的是了解全球范围内 TBI 和中风患者使用 DC 和 DCO 的现状。
设计了一份问卷，并于 2019 年 6 月至 11 月通过电子邮件和社交媒体在全球范围内分发给神经外科医生。
我们收到了来自 60 个国家的 208 份回复[40 个低收入和中等收入国家（LMICs）]。DC 的使用频率高于 DCO，但约四分之一的受访者在超过 25%的患者中使用 DCO。DCO 的三个主要适应证为急性硬膜下血肿（ASDH）和 GCS 为 9-12、ASDH 合并挫伤和 GCS 为 3-8、以及 ASDH 合并挫伤和 GCS 为 9-12。使用了 8 种 DCO 技术，其中大多数（60/125）将缝线松散地系在骨瓣上。大多数（82%）表示有兴趣合作进行 DCO 与 DC 的随机试验。
我们的结果表明，DCO 是用于 TBI 和中风的手术，特别是在 LMICs，最常用于 ASDH。大多数受访者有兴趣合作进行未来的随机试验。
