Analysis of the efficacy of neuroendoscope-assisted postauricular question mark incision and large craniectomy in the treatment of acute severe traumatic subdural hematoma
Objective To explore the effect of neuroendoscopic-assisted postauricular question mark incision large bone flap decompression in the treatment of patients with acute severe traumatic subdural hematoma by comparing with standard large bone flap decompression.Methods The clinical data of 137 patients with acute severe traumatic subdural hematoma diagnosed and treated in the Neurosurgery Department of Siping Central People's Hospital from January 2017 to December 2022 were retrospectively analyzed.All patients underwent intracranial pressure monitoring and external ventricular drainage.Among them,patients treated with neuroendoscopic-assisted postauricular question mark incision large craniectomy decompression were included in the experimental group(n=77),and patients treated with standard large bone flap decompression were included in the control group(n=60).There was no statistically significant difference in baseline data such as gender and age between the two groups of patients(all P＞0.05).The differences in Glasgow Coma Score(GCS),surgery-related complications 1 week after surgery,Glasgow Outcome Scale(GOS),good outcome(GOS level Ⅳ and Ⅴ)rate and mortality rate 3 months after surgery were compared between the two groups.Results Both groups of patients successfully underwent the surgery.Compared with the control group,the patients in the experimental group had higher GCS 1 week after surgery[(14.33± 2.95)points vs.(11.53±3.12)points],and the difference was statistically significant(t=5.37,P＜0.001).There was no statistically significant difference in the incidence of surgery-related complications such as intraoperative malignant encephalocele,postoperative bleeding,intracranial infection,wound non-healing,epileptic seizures,and hydrocephalus between the two groups(all P＞0.05).At the 3-month follow-up after surgery,the difference in GOS between the two groups of patients was statistically significant(Z=-4.40,P＜0.001);the favorable outcome rate of patients in the experimental group was higher than that in the control group[83.1％(64/77)vs.51.7％(31/60),x2=15.69,P＜0.001],while the difference in case fatality rate was not statistically significant[1.3％(1/77)vs.8.3％(5/60),correctedx2=2.48,P=0.115].Conclusion Compared with standard large bone flap decompression,neuroendoscope-assisted postauricular question mark incision large bone flap decompression in the treatment of patients with acute severe traumatic subdural hematoma can achieve better clinical outcome without increasing the risk of surgery-related complications.
Brain injuries,traumaticHematoma,subduralIntracranial pressureNeuroendos-copyTreatment outcomePostauricular question mark incision
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