This study was performed to investigate the effect of early pressure dressing on the prevention of postoperative subdural effusion secondary to decompressive craniectomy (DC) in patients with severe traumatic brain injury (STBI). Patients with STBI who had undergone DC for refractory increased intracranial pressure between January 2008 and December 2011 (n = 169) were randomly divided into early pressure dressing (n = 82) and control (n = 87) groups. Early pressure dressing with an elastic bandage or general wrapping (control treatment) was applied 7 to 10 days after DC. Patients' age, sex, preoperative Glasgow Coma Scale score, incidence rate of subdural effusion, hospitalization time, and postoperative Glasgow Outcome Scale score were compared between groups. Intracranial pressure was measured immediately before and on the day after pressure dressing. No significant difference in age, sex, preoperative Glasgow Coma Scale score, or postoperative Glasgow Outcome Scale score was observed between groups (P > 0.05). Subdural effusion incidence rates were significantly lower in the early pressure dressing group than those in the control group (χ² = 5.449, P = 0.021), and a larger proportion of patients in the early pressure dressing group was hospitalized for 30 days or less (χ² = 5.245, P = 0.027). Early pressure dressing 7 to 10 days after DC, which is a noninvasive, simple procedure, reduced the incidence rate of subdural effusion and shortened hospitalization time after DC for STBI.

Background: Tracheotomy has played an important role in the treatment of patients with severe traumatic brain injury (TBI), the appropriate tracheotomy time will affect the prognosis of patients. However, the timing of tracheostomy after severe TBI remains controversial. To find the optimal time for tracheostomy, the authors compared the effects of early tracheostomy (ET) versus late tracheostomy (LT) on TBI-related outcomes and prognosis. Methods: The clinical data of 98 patients with severe TBI treated by tracheotomy at NICU, First Affiliated Hospital of Xi’an Medical University, January 2017 to January 2018, were analyzed retrospectively. According to the time of the tracheotomy during the treatment, the patients were divided into ET group (after admission <3 days) and LT group (>3 days after admission). The NICU stay, hospital stay, long duration of antibiotic use, pneumonia rates, mortality rates, improvement of nerve function, complications of tracheotomy, and treatment cost were compared between the 2 groups. Results: The NICU stay, hospitalization stay, and antibiotic use time of patients in the ET group were shorter than those in the LT group (P < 0.05). The pneumonia rates and the cost of hospitalization in the ET group were lower than those in the LT group (P < 0.05). The complications of the tracheostomy, mortality, and neurologic function improvements were not statistically significant in the 2 groups (P > 0.05). Conclusion: For severe TBI, ET can reduce the NICU stay, hospitalization stay, length of antibiotic use, and reduce the incidence rates of pneumonia and the cost of hospitalization compared with LT, but there is no significant improvement in the mortality rates and neurologic function of patients during hospitalization.

BackgroundTo evaluate the efficacy of microvascular decompression (MVD) in reducing hypertension (HTN) in hypertensive patients with trigeminal neuralgia (TN).MethodsThe clinical data of 58 cases of neurogenic HTN with TN treated in our hospital were retrospectively reviewed. Preoperative MR revealed abnormal blood pressure in the left rostral ventrolateral medulla (RVLM) and the posterior cranial nerve root entry zone (REZ). The patients were divided into control group: only trigeminal nerve was treated with MVD; experimental group: trigeminal nerve, RVLM and REZ were treated with MVD at the same time. The patients were followed up for 6 months to 1 year to observe the changes of blood pressure.ResultsThere was no significant difference in gender, age, course of TN, course of HTN, grade of HTN and preoperative blood pressure between the two groups. After operation, the effective rate of HTN improvement with MVD was 32.1% in the control group. There was no significant difference in the preoperative and post operative blood pressure. (P△SBP = 0.131; P△BDP = 0.078). In the experimental group, the effective rate was 83.3%. The postoperative blood pressure was significantly lower than preoperative values. (P△SBP < 0.001; P△DBP < 0.001).ConclusionsMVD is an effective treatment for neurogenic HTN. However, the criteria for selecting hypertensive patients who need MVD to control their HTN still needs to be further determined. Possible indications may include: left trigeminal neuralgia, neurogenic HTN; abnormal blood pressure compression in the left RVLM and REZ areas on MR; and blood pressure in these patients can not be effectively controlled by drugs.

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