Huang Huaping, Chen Yang, Hu Wanglu, Yang Shidi, Wu Haijian, Gao Liansheng, Yan Wei
Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine.
Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou.
J Craniofac Surg. 2025;36(5):1649-1654. doi: 10.1097/SCS.0000000000010819. Epub 2025 Mar 10.
Traumatic brain injury (TBI) patients with decompressive craniectomy (DC) frequently accompany the complication of secondary subdural effusion (SDE). In cases where cranioplasty is contraindicated, there are no clear-cut guidelines on surgical approaches for managing subdural effusion resulting from DC. Therefore, the authors conducted this study to compare different surgical procedures for patients with SDE in the context of contraindications for cranioplasty.
The clinical data of 59 patients with SDE following DC for TBI, who had contraindication of cranioplasty and received surgical treatment for SDE, were retrospectively selected from January 2010 to June 2023. The therapeutic efficacy of SDE was assessed based on the dynamic head CT scans performed within 1 month after surgery and the improvement of clinical symptoms. The authors compared the effects of ventricular or subarachnoid drainage (VSD, n = 33) and subdural drainage (SDD, n = 29), which, respectively, serve as CSF of control and direct diversion. Subgroup analysis also considered the presence or absence of hydrocephalus and the associated risk.
This study found that VSD group exhibited superior therapeutic effects compared with SDD group. (75.8% versus 38.4%; P =0.004), with no significant difference in complication ( P =0.543). Subgroup analysis indicates that patients with hydrocephalus who directly received VSD had better treatment effect than SDD (93.3% versus 11.1%, P <0.001), while for patients without hydrocephalus, there was no significant difference between the VSD group and the SDD group (61.1% versus 52.9%, P =0.442). Furthermore, in patients without hydrocephalus but at risk of hydrocephalus, the therapeutic effects of VSD were superior to those of SDD(100% versus 14%, P <0.001).
Our study reveal that VSD could be considered first compare to SDD for SDE patients with contraindications to cranioplastyt, especially when patients have a hydrocephalus or risk factors for hydrocephalus.
接受减压性颅骨切除术（DC）的创伤性脑损伤（TBI）患者常伴有继发性硬膜下积液（SDE）并发症。在颅骨修补术禁忌的情况下，对于处理DC所致硬膜下积液的手术方法尚无明确指南。因此，作者开展本研究以比较在颅骨修补术禁忌背景下SDE患者的不同手术方法。
回顾性选取2010年1月至2023年6月间59例因TBI接受DC后出现SDE且有颅骨修补术禁忌并接受SDE手术治疗的患者的临床资料。基于术后1个月内进行的动态头颅CT扫描及临床症状改善情况评估SDE的治疗效果。作者比较了分别作为脑脊液对照引流和直接引流的脑室或蛛网膜下腔引流（VSD，n = 33）和硬膜下引流（SDD，n = 29）的效果。亚组分析还考虑了脑积水的有无及相关风险。
本研究发现VSD组的治疗效果优于SDD组（75.8%对38.4%；P = 0.004），并发症方面无显著差异（P = 0.543）。亚组分析表明，直接接受VSD的脑积水患者治疗效果优于SDD（93.3%对11.1%，P < 0.001），而对于无脑积水患者，VSD组和SDD组之间无显著差异（61.1%对52.9%，P = 0.442）。此外，在无脑积水但有脑积水风险的患者中，VSD的治疗效果优于SDD（100%对14%，P < 0.001）。
我们的研究表明，对于有颅骨修补术禁忌的SDE患者，尤其是存在脑积水或脑积水风险因素的患者，与SDD相比，可首先考虑VSD。
