Aspects on Decompressive Craniectomy in Patients with Traumatic Head Injuries

Abstract

In patients with traumatic brain injury (TBI), intracranial hypertension secondary to cerebral edema is a major problem. A last-tier treatment in these cases is decompressive craniectomy. The aim of the present retrospective investigation was to (1) study the long-time outcome in patients with traumatic head injuries with intracranial hypertension treated with decompressive craniectomy; (2) examine the effects on intracranial pressure (ICP) by the craniectomy; and (3) investigate the possible relationship between the size of the removed bone-flap and the effects on ICP. Among the about 150 patients with severe TBI treated at our neurointensive care unit during 1997-2002, 19 patients were treated with decompressive craniectomy. All patients were young (mean 22 +/- 11 years, range 7-46 years), and 68% were male. The mean ICP was reduced from 29.2 +/- 3.5 before to 11.1 +/- 6.0 mm Hg immediately after the craniectomy; at 24 h after the craniectomy, the mean ICP was 13.9 +/- 9.7 mm Hg. Paired-samples t-test revealed a statistically significant decrease, both when comparing the preoperative values to the values immediately postoperative as well as to the values after 24 h (p < 0.01). A significant correlation between the size of the craniectomy and the decrease in ICP was found using Pearson regression analysis. The outcome of all patients could be assessed. The survival rate was 89%. Two patients died (both day 4 after the trauma); 68% of the patients had a favorable outcome (Glasgow Outcome Scale [GOS] score of 4 or 5); 16% were severely disabled (GOS score of 3); and one patient (5%) was left in a vegetative state.

Quality of life after hemicraniectomy for traumatic brain injury in adults

“…1,2,4-7,9,11, [14][15][16]18,19,21,22,25,[27][28][29][31][32][33][34][35][36][37][38][39][40] The mean years of patient accrual were between 1987 and 2005. Total numbers in each GOS category are shown in Table 1.…”

Decompressive craniectomy: an effective but underutilized option for intracranial pressure management

“…This results in a dramatic reduction in the ICP and a reversal in the clinical and radiological signs of herniation [1] The concept of surgical expansion of the cranial cavity was fi rst expounded by Cushing, who used the procedure for the management of ICP due to brain tumors [2]. There has been a resurgence of interest in decompressive craniectomy for TBI in the past decade [3].…”

Management of Pediatric Traumatic Brain Injury

“…Each of those studies has used a different type and timing for the procedure, which makes it difficult to draw conclusions, but all procedures were effective at ICP reduction in cases of refractory intracranial hypertension [68][69][70]. The study by Taylor and colleagues demonstrated improved neurologic outcome in patients treated with decompressive craniectomy within 6 h of randomization in comparison to standard therapy [68].…”