To investigate the efficacy and safety of decompression of large bone flap combined with lumbar cistern continuous drainage (LCFD) in patients with severe traumatic brain injury (sTBI).

Eighty six patients with sTBI who were treated in Hai’an Hospital Affiliated to Nantong University from September 2017 to December 2019 were selected as the research objects. According to the random number method, they were divided into simple large bone flap group and combined treatment group with 43 cases in each group. All patients underwent standard large bone flap decompression. LCFD was performed in the combined treatment group on the 3^rd day after operation for 4 d. Intracranial pressure (ICP) was continuously measured from preoperative to 7^th day after operation and GOS scales were evaluated. Interleukin-6 (IL-6) and hypersensitive C-reactive protein (hsCRP) were detected before and 7 d after operation. The levels of S-100B protein in cerebrospinal fluid, brain metabolic [indexes (cerebral perfusion pressure (CPP), cerebral oxygen uptake rate (CEO₂), jugular bulb venous oxygen saturation (SjVO₂)] were observed. The postoperative complications and prognosis were analyzed after 6 months of follow-up.

The treatment was significantly more efficient 7 d after operation in the combined treatment group than in the simple large bone flap group. The difference was statistically significant (χ²=5.103, P=0.037). Seven day after operation, the ICP in the combined treatment group was significantly reduced compared with both pretreatment and the simple large bone flap group, while the GOS score was significantly higher compared with both pre-treatment and the simple large bone flap group, the difference was statistically significant (P<0.05). The serum IL-6, hs-CRP and cerebrospinal fluid S-100B levels in the combined treatment group were significantly reduced compared with both pretreatment and the simple large bone flap group, the difference was statistically significant (P<0.05). The levels of brain metabolic indexes (CPP, CEO₂ and SjVO₂) of the combined treatment group were significantly higher than the simple large bone flap group, the difference was statistically significant (P<0.05). The total incidence of adverse events, including hydrocephalus, intracranial infection, subdural effusion and epilepsy, in the combined treatment group was significantly lower than in the simple large bone flap group, the difference was statistically significant(P<0.05). After 6 months of follow-up, the coma rate and death rate in the combined treatment group were lower than in the simple large bone flap group, the difference was statistically significant (P<0.05).

Compared with standard large trauma craniotomy alone, standard large trauma craniotomy combined with lumbar cistern continuous drainage can significantly reduce the intracranial pressure, reduce the body inflammatory reaction, improve the cerebral perfusion level of patients, so as to improve the prognosis of patients, and the incidence of adverse reactions is low.