Comparative efficacy of hinge decompressive craniotomy with large bone flaps and standard decompressive craniectomy in the treatment of increased intracranial pressure following trauma in children
Objective To compare the efficacy of hinge decompressive craniotomy with large bone flaps and standard decompressive craniectomy in the treatment of increased intracranial pressure following trauma in children.Methods A retrospective cohort study was conducted to analyze the clinical data of 33 children with increased intracranial pressure following trauma,who were admitted to Children's Hospital of Soochow University and Xuzhou Children's Hospital from August 2017 to March 2023,including 25 males and 8 females;aged 2-17 years[(5.9±3.3)years].Glasgow Coma Scale(GCS)score on admission was(6.3±2.l)points,including 3-5 points in 13 patients,6-8 points in 15,and 9-12 points in 5.Of them,19 patients were treated with hinge decompressive craniotomy with large bone flaps(hinge bone flap group)and 14 patients with standard decompressive craniectomy(bone flap group).Invasive intracranial pressure monitoring was performed on 18 patients in the hinge bone flap group and 13 patients in the bone flap group.The operation time,intracranial pressure immediately,at 24,72 hours and 7 days after surgery,proportion of children undergoing cranioplasty/plastic surgery within 6 months after surgery,Glasgow Outcome Scale(GOS)at 3,6 months after surgery and at the last follow-up,and the incidences of complications at 6 months after surgery including subdural effusion,hydrocephalus,infection/necrosis of incisions and epilepsy were compared between the two groups.Results All the patients were followed up for 6-67 months[10(6,45)months].There was no significant difference in the operation time between the two groups(P＞0.05).There was no significant difference in the intracranial pressure immediately,at 24 hours,72 hours and 7 days after surgery(P＞0.05).Within 6 months after surgery,none of the children in the hinge bone flap group had problems of bone flap resorption,etc and the proportion of children undergoing cranioplasty/plastic surgery was 0.0％(0/19),which was lower than that of the bone flap group[78.5％(11/14)](P＜0.01).There was no significant difference in GOS scores of the two groups at 3,6 months after surgery or at the last follow up(P＞0.05).The incidence of postoperative subdural effusion in the hinge bone flap group was 0.0％(0/19),which was lower than that of the bone flap group[28.6％(4/14)](P＜0.05).There were no significant differences in the incidences of postoperative hydrocephalus,incision infection/necrosis or epilepsy between the two groups(P＞0.05).Conclusion Compared with standard decompressive craniectomy,hinge decompressive craniotomy with large bone flaps can avoid the cranioplasty/plastic surgery and reduce the incidence of subdural effusion in the treatment of increased intracranial pressure following trauma in children.
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