To investigate the application value of controlled decompression combined with pre suture craniotomy under intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (sTBI).

One hundred and thirty-six patients with sTBI admitted to Neurosurgery Department of The First People’s Hospital of Huzhou (the First Affiliated Hospital of Huzhou Normal University) from January 2017 to September 2019 were collected. Among them, 57 patients before February 2018 (control group) were treated with routine rapid hematoma clearance and standard large bone flap decompression surgery (without controlled decompression) under ICP monitoring, and 79 patients after March 2018 (study group), controlled decompression under ICP monitoring combined with pre suture craniotomy was adopted. The incidence of intraoperative hypotension, acute encephalocele, delayed intracranial hematoma and other complications, brain tissue exposure time, craniotomy time, unplanned reoperation and GOS score at 6 months after injury were retrospectively analyzed and compared between the two groups. It was clear that the operation mode of controlled decompression combined with presplitting craniotomy under ICP monitoring was effective in the treatment.

There were no significant differences in gender distribution, age, injury to operation time, preoperative GCS score, preoperative mydriasis, imaging data and initial ICP between the two groups (P>0.05). The incidences of intraoperative hypotension, acute encephalocele and delayed intracranial hematoma in the study group were lower than those in the control group, the exposure time and closing time of brain tissue were shorter than those of the control group, the removal rate of bilateral cranial bone flap was lower than that of the control group, the unplanned reoperation rate was lower than that of the control group, the good prognosis rate was significantly higher than that of the control group, and the mortality rate was significantly lower than that of the control group (all P<0.05).

The application of controlled decompression combined with pre suture craniotomy under ICP monitoring can reduce the incidence of intraoperative hypotension, acute encephalocele and delayed intracranial hematoma, reduce the rate of unplanned reoperation or bilateral cranial flap removal, and improve the prognosis of sTBI patients.