ObjectiveTo investigate the effects of large trauma craniotomy on severe traumatic brain injury. MethodsA total of 132 cases of severe traumatic brain injury adopted large trauma craniotomy between July 2008 and August 2013, and the clinical data were retrospectively analyzed. ResultsAccording to the results of GOS assessment at discharge, 67 patients (50.75%) were satisfied, 26 (19.70%) were mildly disable, 10 (7.58%) were severely disable, 12 (9.09%) were in vegetative state, and 17 (12.88%) were dead. ConclusionCorrect use of large trauma craniotomy on severe brain injury cases will help to improve the treatment outcome, reduce complications and improve quality of survival.
ObjectiveTo systematically review the efficacy between key hole approach versus large trauma craniotomy for patients with hypertensive intracerebral hemorrhage. MethodsSuch databases as The Cochrane Library (Issue 3, 2013), PubMed, EMbase, WangFang Data, CNKI and VIP was searched to identify randomized controlled trials (RCTs) on key hole approach versus large trauma craniotomy for patients with hypertensive intracerebral hemorrhage from January 2005 to June 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. ResultsA total of 13 studies involving 1 324 patients was included. The results of meta-analysis showed that, key hole approach was superior to large trauma craniotomy with significant differences in the fatality rate (OR=0.29, 95%CI 0.19 to 0.45, P < 0.000 01), incidence of postoperative complications (OR=0.35, 95%CI 0.21 to 0.57, P < 0.000 1), recovery time of consciousness (MD=-4.52, 95%CI-5.84 to-3.20, P < 0.000 01), neurologic impairment score after 1-month treatment (MD=-12.63, 95%CI-16.36 to-8.90, P < 0.000 01), total effectiveness (OR=3.79, 95%CI 2.54 to 5.66, P < 0.000 01), and postoperative living ability (ADL Grade I, Ⅱ). ConclusionKey hole approach is better than large trauma craniotomy for patients with hypertensive intracerebral hemorrhage. Due to limited quality and quantity of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality studies, especially conducting multicenter blinding RCTs with large sample-size.