BƯỚC ĐẦU ĐÁNH GIÁ KẾT QUẢ PHẪU THUẬT MỞ SỌ GIẢI ÉP KẾT HỢP MỞ BỂ DỊCH NÃO TỦY NỀN SỌ ĐIỀU TRỊ CHẤN THƯƠNG SỌ NÃO NẶNG TẠI BỆNH VIỆN QUÂN Y 103

Abstract

Objectives: To initially evaluate the result and complications of supplementary cisternostomy to decompressive craniectomy for the management of severe brain traumatic injury. Subjects and methods: a prospective, descriptive, interventional, non-controlled study on 16 cases of sTBI surgically treated with cisternostomy (CS) and decompressive craniectomy (DC). Outcome was assessed at the time of discharge (survival, mortality, complications), and after 3 months of discharge based on Glasgow Outcome Scale (GOS). Results: Sixteen patients were examined, with a mean age of 53.19 years. Of these patients, 75% were male. The mean Glasgow Coma Scale (GCS) at the time of intervention was 7 ± 1.15, of the patients, 81.25% did not have a dilated and fixed pupil, 87,5% did not have paralysis. On CT scanners, it was observed that the majority of patients (81.25%) had a combination of subdural hematoma and intraparenchymal hematoma or contusions. Additionally, 87.5% of patients had subarachnoid hemorrhage, while 75% of patients had normal basal cisterns. Midline shift ranging from 5-10mm accounted for the largest proportion, at 43.57%. Following the surgical procedure, there was a significant decrease in intracranial pressure (ICP) compared to before the operation (46.06 ± 9.69 versus 18.94 ± 3.30 mmHg). This represents a reduction of 27.13 ± 9.00 mmHg, which was statistically significant (p < 0.001). At the time of discharge, the survival rate was 81.25%. After three months, the survival rate was 84.6% in the population. Among those who survived, 12.5% experienced early complications, whereas 27.3% experienced late complications. Conclusion: In patients with severe TBI, intracranial pressure was managed by performing a decompressive craniectomy and a supplementary cisternostomy.