A clinical research on the emergent drilling on the skull bone and sequential dura incision in the treatment of the severe head injury with cerebral hernia

doi:10.3969/j.issn.1674-3806.2016.02.12

Abstract：Objective To explore the clinical efficacy of the emergent drilling on the skull bone and sequen-tial dura incision in the treatment of the severe head injury with cerebral hernia.Methods Sixty-four cases with se-vere head injury and cerebral hernia who received surgical treatment in our hospital from January 2012 to December 2014 were randomly divided into group A and group B by the random number table method.Group A received an e-mergent drilling on the skull bone, a standard decompressive craniectomy and the sequential dura incision.Group B received the standard decompressive craniectomy and the one-time dura incision.The incidence of acute encephalo-cele, the change of the pupil size and the prognostics after sixth months of the surgery were compared between the two groups.Results The acute encephalocele was found in 7 cases(21.88%) in group A, and 18 cases(56.25%) in group B, with a significant difference(P<0.01).The normal pupils were found in 10 cases(31.25%), the con-tracted pupils in 18 cases(56.25%) and no change in 4 cases(12.50%) in group A.The counterpart changes oc-curred in group B were 5 cases(15.63%) in normal pupils, 13 cases(40.63%) in contracted pupils and 14 cases (43.75%) without changes.The changes of the pupil size of group A improved better than those of group B( P<0.05).In group A, 2 cases(6.25%) died, 2 cases(6.25%) were in vegetative state, 8 cases(25.00%) were se-verely disable, 8 cases(25.00%) were mildly disable and 12 cases(37.50%) recovered well.In group B, 6 cases (18.75%) died, 5 cases(15.63%) were in vegetative state, 9 cases(28.13%) were severely disable, 7 cases (21.88%) were mildly disable and 5 cases(15.63%) recovered well.Group A recovered better than group B(P<0.05) .Conclusion The emergent drilling on the skull bone and sequential dura incision have significant effects on reducing the intracranial pressure.They can reduce the incidence of the acute encephalocele, improve prognosis and reduce the mortality and morbidity rates.