[Effect of combined decompression operation on middle and late stage cerebral herniation].

Objective: To observe the effect of combined decompression operation on patients with severe traumatic brain injury complicated by tentorial cerebral herniation.

Methods: Ninety-seven patients with an admission Glasgow Coma Scale score 3-5 were randomly divided into two groups: combined decompression group (n=46), in whom tentorium cerebelli was incised (2-4 cm) combined with bone flap craniectomy decompression [(10-15)cm x (15-17)cm], and conventional temporoparietal craniectomy group (n=51). CT scanning was performed in the patients before and after the operation. The patients of both groups received routine treatment and followed up for 1-32 months (mean 7 months) after the operation. The clinical symptoms, change in intracranial pressure and incidence of complications were compared between the two groups.

Results: The efficacious rate was 80.4% (37/46) in the combined decompression group, and among them 27 patients were cured (58.7%) and 10 patients remained to have moderate disability(21.7%). Nine patients (19.6%) died after combined decompression. However, in patients with conventional temporoparietal craniectomy decompression, favorable outcome was only found in 6 cases(11.8%), moderate disability accounted for 21.6% of patients, and 34 patients died(66.6%). In patients with combined decompression, the intracranial pressure was more efficiently lowered compared with conventional craniectomy decompression(P<0.01). Furthermore the incidence of acute brain edema, incisional herniation, traumatic epilepsy, occipital cerebral infarct and cerebro-spinal fluid(CSF) leakage were lower in combined decompression group compared with conventional craniectomy group (P<0.05 or P<0.01). The incidence of intracranial infection was not significantly different between two groups (P>0.05).

Conclusion: Combined decompression is preferable to routine temporoparietal craniectomy for patients with severe head injury complicated by tentorial herniation.