The clinical efficacy of small-window craniotomy on non-progressive trans-sinus epidural hematoma

Abstract

Objective To investigate the clinical efficacy of two surgical approaches, trans-sinus small-window craniotomy (TSSWCT) and combined supratentorial-infratentorial craniotomy (CSITCT), on non-progressive trans-sinus epidural hematoma.  Methods There were 67 patients with non-progressive trans-sinus epidural hematoma who underwent TSSWCT or CSITCT. The postoperative residual hematoma, postoperative alteration of intracranial pressure (ICP), recanalization of affected cerebral venous sinuses, length of hospitalization, and 6-month Glasgow Outcome Scale (GOS) score of patients were retrospectively compared.  Results Compared with patients in the CSITCT group (N = 35), those in the TSSWCT group (N = 32) had significantly reduced postoperative residual hematoma near the venous sinus [(1.40 ± 1.60) ml vs (3.50 ± 2.10) ml, P = 0.000], length of hospitalization [(13.40 ± 5.70) d vs (17.30 ± 7.00) d, P = 0.015], markedly down-regulated levels of intracranial pressure (ICP) at indicated postoperative time points [1 d: (164.40 ± 33.30) mm H₂O vs (198.60 ± 49.30) mm H₂O, P = 0.002; 3 d: (185.90 ± 47.80) mm H₂O vs (226.30 ± 81.60) mm H₂O, P = 0.017; 7 d: (154.70 ± 52.50) mm H₂O vs (198.30 ± 84.20) mm H₂O, P = 0.014)], and distinctly improved recanalization of affected cerebral venous sinuses (87.50% vs 65.70% , P = 0.037). Moreover, the 6-month GOS scores were not statistically different between patients in 2 groups (Z = -0.114, P = 0.909).  Conclusions Compared with CSITCT, TSSWCT is a reliable surgical approach in the treatment of non-progressive trans-sinus epidural hematoma which has strengthened capability of evacuating hematoma underlying affected venous sinuses, relieving the compressed venous sinus and attenuating the intracranial hypertension.

DOI: 10.3969/j.issn.1672-6731.2015.02.011