Zhang Zhong-Ding, Zhao Li-Yan, Liu Yi-Ru, Zhang Jing-Yu, Xie Shang-Hui, Lin Yan-Qi, Tang Zhuo-Ning, Fang Huang-Yi, Yang Yue, Li Shi-Ze, Liu Jian-Xi, Sheng Han-Song
Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.
Front Surg. 2022 Jul 1;9:877038. doi: 10.3389/fsurg.2022.877038. eCollection 2022.
Severe traumatic brain injury (TBI) patients usually need decompressive craniectomy (DC) to decrease intracranial pressure. Duraplasty is an important step in DC with various dura substitute choices. This study aims to compare absorbable dura with nonabsorbable dura in duraplasty for severe TBI patients.
One hundred and three severe TBI patients who underwent DC and dura repair were included in this study. Thirty-nine cases used absorbable artificial dura (DuraMax) and 64 cases used nonabsorbable artificial dura (NormalGEN). Postoperative complications, mortality and Karnofsky Performance Scale (KPS) score in one year were compared in both groups.
Absorbable dura group had higher complication rates in transcalvarial cerebral herniation (TCH) (43.59% in absorbable dura group vs. 17.19% in nonabsorbable dura group, = 0.003) and CSF leakage (15.38% in absorbable dura group vs. 1.56% in nonabsorbable dura group, = 0.021). But severity of TCH described with hernial distance and herniation volume demonstrated no difference in both groups. There was no statistically significant difference in rates of postoperative intracranial infection, hematoma progression, secondary operation, hydrocephalus, subdural hygroma and seizure in both groups. KPS score in absorbable dura group (37.95 ± 28.58) was statistically higher than nonabsorbable dura group (49.05 ± 24.85) in one year after operation ( = 0.040), while no difference was found in the rate of functional independence (KPS ≥ 70). Besides, among all patients in this study, TCH patients had a higher mortality rate ( = 0.008), lower KPS scores ( < 0.001) and lower functionally independent rate ( = 0.049) in one year after surgery than patients without TCH.
In terms of artificial biological dura, nonabsorbable dura is superior to absorbable dura in treatment of severe TBI patients with DC. Suturable nonabsorbable dura has fewer complications of TCH and CFS leakage, and manifest lower mortality and better prognosis. Postoperative TCH is an important complication in severe TBI which usually leads to a poor prognosis.
重型创伤性脑损伤（TBI）患者通常需要进行去骨瓣减压术（DC）以降低颅内压。硬脑膜成形术是DC中的重要步骤，有多种硬脑膜替代物可供选择。本研究旨在比较用于重型TBI患者硬脑膜成形术的可吸收硬脑膜和不可吸收硬脑膜。
本研究纳入了103例行DC及硬脑膜修复的重型TBI患者。39例使用可吸收人工硬脑膜（DuraMax），64例使用不可吸收人工硬脑膜（NormalGEN）。比较两组术后并发症、死亡率及1年内的卡氏功能状态评分（KPS）。
可吸收硬脑膜组经颅骨脑疝（TCH）的并发症发生率较高（可吸收硬脑膜组为43.59%，不可吸收硬脑膜组为17.19%，P = 0.003），脑脊液漏发生率也较高（可吸收硬脑膜组为15.38%，不可吸收硬脑膜组为1.56%，P = 0.021）。但用疝距和疝体积描述的TCH严重程度在两组间无差异。两组术后颅内感染、血肿进展、二次手术、脑积水、硬膜下积液和癫痫发生率无统计学差异。术后1年可吸收硬脑膜组的KPS评分（37.95±28.58）在统计学上高于不可吸收硬脑膜组（49.05±24.85）（P = 0.040），而功能独立性（KPS≥70）率无差异。此外，在本研究的所有患者中，术后1年TCH患者的死亡率较高（P = 0.008），KPS评分较低（P < 0.001），功能独立性率较低（P = 0.049）。
就人工生物硬脑膜而言，不可吸收硬脑膜在治疗行DC的重型TBI患者方面优于可吸收硬脑膜。可缝合的不可吸收硬脑膜TCH和脑脊液漏并发症较少，死亡率较低，预后较好。术后TCH是重型TBI的重要并发症，通常导致预后不良。
