Analysis of direct costs of decompressive craniectomy in victims of traumatic brain injury

Badke, Guilherme Lellis; Araújo, João Luiz Vitorino; Miura, Flávio Key; Guirado, Vinícius Monteiro de Paula; Saade, Nelson; Paiva, Aline Lariessy Campos; Avelar, Tiago Marques; Pedrozo, Charles Alfred Grander; Veiga, José Carlos Esteves

doi:10.1590/0004-282x20180016

Cited by 9 publications

(8 citation statements)

References 29 publications

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“…Traumatic brain injury is a major cause of morbidity and mortality, especially in developing countries. 2 Direct traumas generally cause focal lesions, such as epidural hematomas, brain contusions, and skull fractures. 1 The neurosurgery procedures for draining these hematomas, if they have significant repercussion, are well established in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…However, many huge trials, such as DECRA and RESCUE-ICP, have demonstrated that this procedure has high morbidity and mortality rates. 1,2,9 The technique and indications of DC have been extensively described in previous studies; 4,10 nevertheless, the outcomes and costs are high, and these patients always require at least one more neurosurgical procedure for cranioplasty.…”

Section: Discussionmentioning

confidence: 99%

“…1 A Brazilian retrospective study has shown an elevated cost associated with decompressive craniectomy (DC) for TBI. 2 In the past decades, the incidence of trauma has significantly increased, and it is predicted that in few years it will surpass the incidence of some chronic conditions, such as vascular diseases. 3 The importance of this theme is clear; nevertheless, few advances have been made in the last years, especially regarding neurosurgical approaches.…”

Section: Introductionmentioning

confidence: 99%

“…6 Thus, DC is associated with elevated costs and few benefits. 2 In this context, a well-defined technique, previously used in skull base and vascular surgeries, has been proposed to improve cerebrospinal fluid (CSF) flow, brain hydrodynamic and avoid DC. 1 Cisternostomy is a technique in which the basal cisternae are opened, thus helping brain relaxation and, consequently, eliminating the need for DC.…”

Section: Introductionmentioning

confidence: 99%

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2020

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Introduction Traumatic brain injury (TBI) is a major cause of mortality around the world. Few advances regarding surgical approaches have been made in the past few years to improve its outcomes. Microsurgical cisternostomy is a well-established technique used in vascular and skull base surgery and recently emerges as a suitable procedure with lesser costs and morbidity when compared with decompressive craniectomy in patients with diffuse TBI. This study aims to describe the technique, indications, and limitations of cisternostomy and to compare it with decompressive craniectomy (DC). Methods A prospective study is being conducted after obtaining approval of the local human ethics research committee. Once the inclusion and exclusion criteria are applied, the patients are submitted to microsurgical cisternostomy, pre and postoperative neurological status and brain computed tomography (CT) evaluation. A detailed review was also performed, which discusses diffuse TBI, DC, and cisternostomy for the treatment of TBI. Results Two patients were submitted to cisternostomy after TBI and the presence of acute subdural hematoma and huge midline shift at admission computed tomography. The surgery was authorized by the family (the informed consent form was signed). Both patients evolved with a good recovery after the procedure, and had a satisfactory control brain CT. No further surgeries were required after the initial cisternostomy. Conclusions Cisternostomy is an adequate technique for the treatment of selected patients affected by diffuse TBI, and it is a proper alternative to DC with lesser costs and morbidity, since a single neurosurgical procedure is performed. A prospective study is being conducted for a better evaluation and these were the initial cases of this new protocol.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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2020

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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“…Unfortunately, raw cost data was not available in the included studies. However, DC is thought to be an expensive procedure with a mean patient cost of over US$ 20,000 when performed in a developing country [34]. HC is potentially a cheaper alternative due to autologous tissues being utilised and reducing the need for a second operation for a cranioplasty [26].…”

Section: Cost-effectivenessmentioning

confidence: 99%

Hinge/floating craniotomy as an alternative technique for cerebral decompression: a scoping review

et al. 2019

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Hinge craniotomy (HC) is a technique that allows for a degree of decompression whilst retaining the bone flap in situ, in a 'floating' or 'hinged' fashion. This provides expansion potential for ensuing cerebral oedema whilst obviating the need for cranioplasty in the future. The exact indications, technique and outcomes of this procedure have yet to be determined, but it is likely that HC provides an alternative technique to decompressive craniectomy (DC) in certain contexts. The primary objective was to collate and describe the current evidence base for HC, including perioperative parameters, functional outcomes and complications. The secondary objective was to identify current nomenclature, operative technique and operative decisionmaking. A scoping review was performed in accordance with the PRISMA-ScR Checklist. Fifteen studies totalling 283 patients (mean age 45.1 and M:F 199:46) were included. There were 12 different terms for HC. The survival rate of the cohort was 74.6% (n = 211). Nine patients (3.2%) required subsequent formal DC. Six studies compared HC to DC following traumatic brain injury (TBI) and stroke, finding at least equivalent control of intracranial pressure (ICP). These studies also reported reduced rates of complications, including infection, in HC compared to DC. We have described the current evidence base of HC. There is no evidence of substantially worse outcomes compared to DC, although no randomised trials were identified. Eventually, a randomised trial will be useful to determine if HC should be offered as first-line treatment when indicated.

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Accuracy of acute hyperglycemia as a biomarker of severe brain damage in children with traumatic brain injury

Melo,

de Brito Tischer,

Rodrigues

et al. 2024

Childs Nerv Syst

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Analysis of direct costs of decompressive craniectomy in victims of traumatic brain injury

Abstract: Decompressive craniectomy for TBI is an expensive procedure that is also associated with high morbidity and mortality. This was the first study performed in a developing country that aimed to evaluate the direct costs. Prevention measures should be a priority.

Cited by 9 publications

References 29 publications

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Hinge/floating craniotomy as an alternative technique for cerebral decompression: a scoping review

Accuracy of acute hyperglycemia as a biomarker of severe brain damage in children with traumatic brain injury

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