分析早期颅骨修补治疗颅脑损伤大骨瓣减压术后顽固性硬膜下积液的效果及机制。

选取解放军第二五一医院神经外科自2014年1月至2019年1月收治的因颅脑损伤术后行去骨瓣减压并发硬膜下积液患者20例，给予皮下或颅骨钻孔引流、局部加压、腰大池引流及大脑外侧裂池开放等方法后效果不明显，4~6周后行颅骨修补后观察硬膜下积液变化。

2例患者术后出现局部伤口感染，经过积极换药抗生素治疗后甚至痊愈；5例患者术后1个月复查CT硬膜下积液减少不明显，术后3、6个月后随访发现积液逐渐减少消失；其余患者均取得良好的效果，神经功能障碍不同程度恢复，随访硬膜下积液未再复发。

早期颅骨修补术能有效治疗顽固性性硬膜下积液。

To assess the effect and mechanism of early cranioplasty for the treatment of intractable subdural effusion after large decompressive craniotomy for traumatic brain injury.

Twenty traumatic brain injury patients with subdural effusion after decompression craniotomy were selected from Neurosurgery Department of 251 Hospital of PLA from January 2014 to January 2019. All these patients had received subcutaneous or skull burr hole drainage, local pressure, lumbar drainage or cistern dissection, which gained little beneficial effect. They received cranioplasty 4-6 weeks after decompressive craniotomy. The alteration of subdural effusion was observed to assess the effect of early cranioplasty.

Local wound infection occurred in 2 patients after operation and recovered after active dressing change and antibiotics treatment; Subdural effusion was not significantly reduced in 5 patients revealed from the 1^st month CT reexamine after operation, and gradually decreased and disappeared revealed from the 3^nd and 6^th month follow-up after the operation; the rest patients achieved good results, neurological dysfunction recovered to varying degrees, and no recurrence of subdural effusion was observed during follow-up.

Early cranioplasty can effectively treated intractable subdural effusion.