Comparison of the clinical efficacy between limited craniotomy and standard decompressive craniectomy in the treatment of middle-aged and elderly patients with spontaneous cerebral hemorrhage

doi:10.11958/20253058

Abstract

Abstract:

Objective To explore the differences of perioperative indicators, inflammatory response and neurological prognosis between small bone window craniotomy and traditional large bone flap craniotomy in middle-aged and elderly patients with spontaneous intracerebral hemorrhage (SICH). Methods A total of 133 middle-aged and elderly SICH patients were selected and 94 were included after propensity score matching. Patients were divided into the small bone window group (47 cases) and the large bone flap group (47 cases) according to the surgical methods. The baseline data (gender, age, smoking history, drinking history, history of hypertension, diabetes, cerebrovascular disease and coronary heart disease), surgical related indicators (operation time, hospital stay and postoperative fever days), C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC) on postoperative 1, 3 and 7 days, preoperative and postoperative hematoma volume and hematoma clearance rate, Glasgow Coma Scale (GCS), 90-day mortality and modified Rankin Scale (mRS) were compared on admission and postoperative 1, 3, 7 and 14 days between the two groups. Results There were no statistically significant differences in age, gender, smoking history, drinking history, history of hypertension, diabetes, cerebrovascular disease and coronary heart disease, hospital stay, postoperative fever days, WBC, preoperative and postoperative hematoma volume and hematoma clearance rate, GCS score, 90-day mRS score distribution and 90-day cumulative survival rate between the two groups. The operation time of the small bone window group was shorter than that of the large bone flap group, and the CRP and PCT levels on postoperative 3 days were lower than those of the large bone flap group (P<0.01). Conclusion Small bone window craniotomy for middle-aged and elderly patients with SICH can achieve a comparable long-term prognosis compared to that of large bone flap decompression, and it has the advantages of shorter operation time and milder postoperative inflammatory response.

Key words: cerebral hemorrhage, hematoma, C-reactive protein, middle-aged, limited craniotomy, decompressive craniectomy, neuroinflammation

CLC Number:

R743.34

Figures/Tables 9

References 18

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组别	n		年龄/岁		男性		吸烟史		饮酒史
大骨瓣组	47		63.68±8.78		33（70.21）		36（76.60）		37（78.72）
小骨窗组	47		63.91±13.32		35（74.47）		36（76.60）		34（72.34）
t或χ²			0.101		0.213		0.000		0.518
组别		高血压史		糖尿病史		脑血管病史		冠心病史
大骨瓣组		15（31.91）		40（85.11）		33（70.21）		5（10.64）
小骨窗组		14（29.79）		39（82.98）		32（68.09）		5（10.64）
t或χ²		0.050		0.079		0.050		0.000

组别	n		年龄/岁		男性		吸烟史		饮酒史
大骨瓣组	47		63.68±8.78		33（70.21）		36（76.60）		37（78.72）
小骨窗组	47		63.91±13.32		35（74.47）		36（76.60）		34（72.34）
t或χ²			0.101		0.213		0.000		0.518
组别		高血压史		糖尿病史		脑血管病史		冠心病史
大骨瓣组		15（31.91）		40（85.11）		33（70.21）		5（10.64）
小骨窗组		14（29.79）		39（82.98）		32（68.09）		5（10.64）
t或χ²		0.050		0.079		0.050		0.000

组别	手术时间/h	住院天数/d	术后发热天数/d
大骨瓣组	5.8±1.4	18.0（13.50，28.00）	10.00（2.25，14.00）
小骨窗组	4.4±1.2	23.0（17.00，31.00）	9.50（3.00，15.00）
t或Z	5.408^＊＊	0.484	0.438

组别	手术时间/h	住院天数/d	术后发热天数/d
大骨瓣组	5.8±1.4	18.0（13.50，28.00）	10.00（2.25，14.00）
小骨窗组	4.4±1.2	23.0（17.00，31.00）	9.50（3.00，15.00）
t或Z	5.408^＊＊	0.484	0.438

组别		CRP/（mg/L）
组别		术后1 d	术后3 d		术后7 d
大骨瓣组		32.8（4.7，68.6）	136.0（74.9，177.0）		77.6（47.0，105.0）
小骨窗组		29.8（9.0，99.0）	82.2（45.3，95.5）		52.9（29.4，93.1）
Z		0.507	3.580^＊＊		1.258
组别			PCT/（μg/L）
组别			术后1 d		术后3 d		术后7 d
大骨瓣组			0.39（0.14，1.24）		0.21（0.18，0.64）		0.10（0.06，0.21）
小骨窗组			0.17（0.08，0.42）		0.16（0.08，0.29）		0.10（0.05，0.23）
Z			2.251		3.199^＊＊		0.330
组别	WBC/（×10?/L）
组别	术后1 d			术后3 d		术后7 d
大骨瓣组	11.47（8.99，14.96）			10.44（7.62，12.99）		9.81（7.92，12.12）
小骨窗组	11.70（9.61，15.30）			9.20（8.06，12.02）		10.37（8.30，12.58）
Z	0.492			0.547		0.894