Study on the Correlation between Bone Window Design in Decompressive Craniectomy for Spontaneous Intracerebral Hemorrhage and the Formation of Postoperative Subdural Effusion

Objective: To study the correlation between bone window design in decompressive craniectomy for spontaneous intracerebral hemorrhage and the formation of postoperative subdural effusion. Methods: 36 patients with spontaneous intracerebral hemorrhage who underwent decompressive craniectomy in our hospital from September 2020 to September 2022 were selected as the research subjects. All patients were divided into a case group (with subdural effusion, n = 16) and a control group (without subdural effusion, n = 20) based on whether they developed subdural effusion within 2 weeks after surgery. The situation of hemorrhage breaking into the ventricles was compared between the two groups, and skull CT thin-layer scan was performed after decompressive craniectomy to reconstruct the skull in three dimensions. The distance from the edge of the decompression window to the midline, the height of the decompression window, the maximum anteroposterior diameter of the decompression window, and the maximum area of the decompression window were measured. Results: There were no significant differences in gender, age, hemorrhage volume, and hemorrhage location between the two groups (P > 0.05), indicating comparability. There were significant differences in the height of the decompression window, the maximum anteroposterior diameter of the decompression window, and the area of the decompression window between the case group and the control group (P < 0.05). There were no significant differences in whether the hemorrhage broke into the ventricles and the distance from the edge of the decompression window to the midline (P > 0.05). Patients with a decompression window height greater than 8 cm, an anteroposterior diameter greater than 10 cm, and an area greater than 50 cm2 had a higher probability of developing postoperative subdural effusion (P = 0.018, 0.0008, 0.013 < 0.05). Conclusion: The height, maximum anteroposterior diameter, and area of the decompression window are important factors affecting the formation of postoperative subdural effusion after decompressive craniectomy. Optimizing the design of the decompression window and avoiding excessively large bone windows can help reduce the incidence of postoperative subdural effusion and improve patient prognosis.