Prospective randomized controlled study on small-window craniotomy versus ordinary large-window craniotomy in the evacuation of epidural hematoma

There is still controversy on the clinical efficacy of small-window craniotomy (SWCT) for acute epidural hematoma with concurrent early-phase cerebral herniation. This study compared multiple surgical and prognostic parameters of SWCT versus ordinary large-window craniotomy (LWCT), which aimed at providing evidences for surgical decision. Compared with LWCT (N = 51), SWCT (N = 44) displayed shortened average operation time (P = 0.000), reduced intraoperative blood loss (P = 0.000) and lessened intraoperative blood transfusion (P = 0.031). Moreover, there was no differences of postoperative residual hematoma (P = 0.141), postoperative palinesthesia time (P = 0.201), the ratio of postoperative secondary ischemia (P = 0.865) or cerebral edema (P = 0.879), and 6-month Glasgow Outcome Scale (GOS) score (P = 0.603) between the two surgical approaches. Results suggested that, for patients with acute epidural hematoma and concurrent early-phase cerebral herniation, SWCT could effectively evacuate hematoma and relief brain herniation without significant differences of effect and prognosis from LWCT. In addition, SWCT has several advantages such as significantly reduced operation time, intraoperative blood loss and blood transfusion. doi: 10.3969/j.issn.1672-6731.2014.05.013