BACKGROUND Midline shift in trauma relates to the severity of head injury. Large craniectomies are thought to help resolve brain shift but can be associated with higher rates of morbidity. This study explores the relationship between craniectomy size and subtemporal decompression for acute subdural haematomas with the resolution of brain compression and outcomes. No systematic study correlating these measures has been reported. METHOD A retrospective study of all adult cases of acute subdural haematomas that presented to a Major Trauma Centre and underwent a primary decompressive craniectomy between June 2008 and August 2013. Data collection included patient demographics and presentation, imaging findings and outcomes. All imaging metrics were measured by two independent trained assessors. Compression was measured as midline shift, brainstem shift and cisternal effacement. RESULTS Thirty-six patients with mean age of 36.1 ± 12.5 (range 16-62) were included, with a median follow-up of 23.5 months (range 2.2-109.6). The median craniectomy size was 88.7 cm2 and the median subtemporal decompression was 15.0 mm. There was significant post-operative resolution of shift as measured by midline shift, brainstem shift and cisternal effacement score (all p < .00001). There was no mortality, and the majority of patients made a good recovery with 82.8% having a Modified Rankin Score of 2 or less. There was no association between craniectomy size or subtemporal decompression and any markers of brain shift or outcome (all R2 < 0.05). CONCLUSIONS This study suggests that there is no clear relationship between craniectomy size or extent of subtemporal decompression and resolution of brain shift or outcome. Further studies are needed to assess the relative efficacy of large craniectomies and the role of subtemporal decompression.

中文翻译：

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硬膜下血肿的颅骨切除术大小及其对脑移位和结局的影响。

背景技术创伤中线转移涉及头部受伤的严重程度。大的颅骨切开术被认为有助于解决脑转移，但可能与更高的发病率相关。本研究探讨了颅脑硬膜下血肿的颅骨切除术大小与颞下减压之间的关系，以及脑压的大小和预后。没有关于这些措施的系统研究报道。方法回顾性分析2008年6月至2013年8月期间在大创伤中心就诊的所有成人硬膜下硬膜下血肿的成人病例，并进行了一次减压性颅骨切除术。数据收集包括患者的人口统计学和表现，影像学表现和结果。所有成像指标均由两名经过培训的独立评估师进行测量。以中线偏移量衡量压缩，脑干移位和脑水肿。结果纳入了36例平均年龄36.1±12.5（范围16-62）的患者，中位随访23.5个月（范围2.2-109.6）。中位颅骨切除术大小为88.7 cm2，中位颞下减压为15.0 mm。通过中线移位，脑干移位和脑水面抹除评分可测量出术后移位的显着性（所有p <.00001）。没有死亡率，大多数患者恢复良好，改良兰金评分为2或更低的占82.8％。颅骨切除术的大小或颞下减压与脑转移或预后的任何指标之间均无关联（所有R2 <0.05）。结论这项研究表明，颅骨切除术的大小或颞下减压的程度与脑移位或结局的解决之间没有明确的关系。需要进一步的研究来评估大颅骨切除术的相对疗效以及颞下减压的作用。