Effect of large decompressive craniectomy combined with vascular reconstruction on cerebral perfusion in patients with severe brain injury

Objective　To compare the efficacies of large decompressive craniectomy combined with vascular reconstruction and traditional decompressive craniectomy in treatment of severe brain injury. Methods　Forty-eight patients with severe brain injury, which was dominated by brain contusion to the frontoparietal lobes, admitted to our hospital from March 2012 to March 2014 were divided equally into experimental group and control group. The patients in the experimental group underwent large decompressive craniectomy combined with vascular reconstruction, and the patients in the control group received traditional decompressive craniectomy. The hemodynamic changes including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP) and the ratios of these values (rCBF, rCBV, rMTT and rTTP) on two sides were observed by CT perfusion imaging, and the Glasgow outcome score (GOS) was analyzed 6 months after operation. Results　The CBF and CBV scores in experimental group were higher than those in the control group at 1 week and 1 month after the operation (P 0.05). The rate of satisfactory recovery (including good recovery and moderate disability) was higher in the experimental group than in the control group, while the rate of poor recovery (including severe disability, vegetative state and death) was lower in the experimental group than in the control group (P<0.05). Conclusion　The large decompressive craniectomy combined with vascular reconstruction can not only decrease the intracranial pressure, but also recover the blood supply of brain, thus deserving the clinical application and popularization. DOI: 10.11855/j.issn.0577-7402.2015.11.15