Clinical efficacy of preoperative burr hole drainage decompression in the treatment of trau-matic cerebral hernia
Huang Wei
Zhang Yuan
Zou Xiaojun
Luo Fei
Li Jun
Tang Zhihui
Fu Liang
Zhuang Zhixiang
Wang Wenhao
Abstract：Objective To investigate the clinical efficacy of preoperative burr hole drainage in managing trauma patients with traumatic cerebral hernia.Methods A retrospective analysis was conducted on 40 traumatic brain injury(TBI)patients with brain herniation admitted to our department from Jan.2019 to Jan.2023.Among them,there were 27 males and 13 females,aged 18-71 years,with a mean age of 47.4 years.After admission,all pa-tients were implanted with intracranial pressure(ICP)probes.According to their willingness,patients were divided into the conventional group(routine dehydration drugs before craniotomy,n=16)and pre-decompression group(e-mergency bedside burr hole drainage in addition to routine dehydration drugs before craniotomy,n=24).General data,GCS and ICP on admission were comparable between the two groups.Statistical analysis was conducted on re-lated perioperative(craniotomy)variables,including pre-and post-operative ICP,postoperative degree of pupil re-traction,incidence of large-scale cerebral infarction,procedure-related bleeding,and postoperative infection,as well as outcomes by Glasgow outcome scale(GOS)score.Results Compared to the conventional group,patients in the pre-decompression group demonstrated significantly lower ICP(mmHg)both before(25.3±5.0 vs.36.6±5.5)and after(18.5±4.7 vs.23.9±5.8)craniotomy(both P<0.01),much better pupil retraction after craniotomy(P<0.05),and much lower incidence of traumatic large-scale cerebral infarction(6 cases,25%vs.9 cases,56.3%,P<0.05);while the incidence of procedure-related bleeding(1 case vs.0 case)and postoperative infec-tion(1 case vs.1 case)revealed no significant difference(all P>0.05).Moreover,the 6-month GOS was much higher in the pre-decompression group than in the conventional treatment group(P<0.05).Conclusion For se-vere TBI patients with brain herniation,burr hole drainage before craniotomy can significantly alleviate intracranial hypertension before and after craniotomy,prevent postoperative massive cerebral infarction,and improve the prognosis of the patients.The procedure is safe and reliable,without increased procedure-related bleeding or postoperative in-fection.As a result,burr hole drainage can be an effective method for pre-decompression to prolong the golden hour for such patients,and is worthy of further clinical promotion.
Keywords：Severe traumatic brain injuriesCerebral herniaPre-decompressionBurr hole drainage
Publication Date：2025-11-15
Online Publishing Date：2025-12-09(First online date of this platform, not the publication date of the document)
Pages：6( 838-843 )