Effect of bone flap reduction on unilateral acute subdural hematoma under intracranial pressure monitoring

Objective To investigate the effect of bone flap reduction on unilateral acute subdural hematoma (ASDH) under intracranial pressure monitoring. Methods A retrospective case control study was conducted to analyze the clinical data of 139 patients with unilateral ASDH admitted to the First Affiliated Hospital of Xinjiang Medical University from July 2014 to December 2017. There were 84 males and 55 females, aged 19-87 years (mean, 53 years). At the time of admission, the Glasgow Coma Score (GCS) was 3-5 points in 63 patients and 6-8 points in 76. There were 40 patients with unilateral cavity dilation and 16 cases with bilateral pupil dilation. According to the different surgical methods, the patients were divided into study group (n=61) and control group (n=78). The study group removed the cranial hematoma under cranial pressure monitoring and determined whether to perform bone flap reduction according to the actual intracranial pressure. The control group was treated with craniotomy hematoma removal and standard large bone decompressed craniectomy (DC). The success rate of bone flap reduction in the study group was recorded. The complications at postoperative 3 months and the Glasgow Outcome Score (GOS) at postoperative 6 months were compared. Results All patients were followed up for 1-6 months, average 5.5 months. In the study group, 23 patients underwent bone flap reduction, and the bone flap reduction rate was 38%. At postoperative 3 months, the study group showed better efficacy in subdural effusion (9 ∶25), hydrocephalus (7 ∶19), and brain swelling in the skull defect area(5 ∶18) than the control group (P<0.05). Based on the GOS at 6 months after operation, in the study group, 25 patients were with good results, nine with moderate disability, 10 with heavy disability, seven with plant survival, and 10 died; in the control group, six patients were with good results, 21 with moderate disability, 15 with heavy disability, 10 with plant survival, and 26 died. The number of patients with good prognosis (good and moderate disability) and the number of deaths in the study group were statistically different from those in the control group (P<0.05). Conclusion In the treatment of unilateral ASDH, bone flap reduction under intracranial pressure monitoring can reduce the incidence of complications and improve the life quality of patients. Key words: Intracranial pressure; Hematoma, subdural, acute; Reconstructive surgical procedure