Decompressive craniectomy for the treatment of high intracranial pressure in closed traumatic brain injury

Sahuquillo, Juan; Dennis, Jane A

doi:10.1002/14651858.cd003983.pub3

Cited by 87 publications

(85 citation statements)

References 207 publications

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“… 4 Randomized controlled trials and guidelines have evaluated the benefits of DC over optimal medical treatment in cases of TBI with intracranial hypertension and recommend this procedure to improve neurologic outcomes and lower mortality rates. 4 5 6 7 Few studies in our country have issued this problem, 8 9 so we aimed to evaluate our experience of consecutive patients with severe TBI who underwent DC in our institution and analyze in-hospital mortality-associated factors.…”

Section: Introductionmentioning

confidence: 99%

Decompressive Craniectomy for Traumatic Brain Injury: In-hospital Mortality-Associated Factors

Celi

Saal‐Zapata

2020

JNRP

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Objective Determine predictors of in-hospital mortality in patients with severe traumatic brain injury (TBI) who underwent decompressive craniectomy. Materials and Methods This retrospective study reviewed consecutive patients who underwent a decompressive craniectomy between March 2017 and March 2020 at our institution, and analyzed clinical characteristics, brain tomographic images, surgical details and morbimortality associated with this procedure. Results Thirty-three (30 unilateral and 3 bifrontal) decompressive craniectomies were performed, of which 27 patients were male (81.8%). The mean age was 52.18 years, the mean Glasgow coma scale (GCS) score at admission was 9, and 24 patients had anisocoria (72.7%). Falls were the principal cause of the trauma (51.5%), the mean anterior–posterior diameter (APD) of the bone flap in unilateral cases was 106.81 mm (standard deviation [SD] 20.42) and 16 patients (53.3%) underwent a right-sided hemicraniectomy. The temporal bone enlargement was done in 20 cases (66.7%), the mean time of surgery was 2 hours and 27 minutes, the skull flap was preserved in the subcutaneous layer in 29 cases (87.8%), the mean of blood loss was 636.36 mL,and in-hospital mortality was 12%. Univariate analysis found differences between the APD diameter (120.3 mm vs. 85.3 mm; p = 0.003) and the presence of midline shift > 5 mm (p = 0.033). Conclusion The size of the skull flap and the presence of midline shift > 5 mm were predictors of mortality. In the absence of intercranial pressure (ICP) monitoring, clinical and radiological criteria are mandatory to perform a decompressive craniectomy.

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Section: Introductionmentioning

confidence: 99%

Decompressive Craniectomy for Traumatic Brain Injury: In-hospital Mortality-Associated Factors

Celi

Saal‐Zapata

2020

JNRP

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“…Despite recommendations by the Brain Trauma Foundation supporting the use of these therapies for sTBI, there is no level I evidence demonstrating improvement in patient outcomes through de nitive, surgical management of TBI [17,24]. DC has been performed for the purpose of relieving elevated intracranial pressure with outcome improvement in speci c TBI patients [25].DC holds the promise of reduced mortality, but long term neurological outcomes and indications remain controversial [10].…”

Section: Discussionmentioning

confidence: 99%

“…Decompressive craniectomy (DC) is a surgical procedure in which a large component of the bony skull is removed and the underlying dura mater is opened [8].Primary DC refers to leaving a large bone ap out after the evacuation of an intracranial hematoma in the early phase after a TBI [9]. DC holds the promise of reduced mortality, but long term neurological outcomes and indications remain controversial [10]. However, the indications for DC remain di cult to de ne for the surgeon in the emergency setting [11].…”

Section: Introductionmentioning

confidence: 99%

Effect of primary decompressive craniectomy on outcomes in severe traumatic brain injury with mass lesions and the independent predictors for operation decision

Yang

Zhang

Zhu

et al. 2020

Preprint

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Background: Although operative indications for traumatic brain injury (TBI) have been evaluated, neurosurgeons often face a dilemma of whether or not to remove the bone flap after mass lesion evacuation, and a useful predictive scoring model for which patients should be decompressive craniectomy (DC) has yet to be developed. The aim of this study was firstly to compare the outcomes of craniotomy and DC, and secondly to determine independent predictors and develop a multivariate logistic regression equation to determine whom should perform primary DC in TBI patients with mass lesions.Methods: A total of nine different variables were evaluated. All 245 patients with severe TBI in this study were retrospectively evaluated between June 2015 and May 2019 and all underwent decompressive craniectomy (DC) or craniotomy for mass lesion removal. The 6-month mortality and Extended Glasgow Outcome Scale (GOSE) were compared between DC and craniotomy. By using univariate, multiple logistic regression and prognostic regression scoring equations it was possible to draw Receiver Operating Characteristic curves (ROC) to predict the decision for DC.Results: The overall 6-month mortality in the entire cohort was 11.43% (28/245). DC patients had a lower mean preoperative Glasgow Coma Scale (GCS) (p = 0.01); more patients with GCS of 6 (p=0.007);more unresponsive pupillary light reflex (p< 0.001); more closed basal cisterns (p< 0.001); and more patients with diffuse injury (p=0.025) than craniotomy patients. Given the greater severity, patients undergoing primary DC had higher 6-month mortality than the remainder of the cohort. However, in the surviving patients, the favorable GOSE rate was similar in two groups. We found that pupillary light reflex and basal cisterns were independent predictors for DC decision. Using ROC curve to predict the probability of DC, the sensitivity was 81.6% and the specificity was 84.9%.Conclusion: Our preliminary findings showed that the primary DC may benefit subgroups of sTBI with mass lesions, and unresponsive pre-op pupil reaction, and closed basal cistern to predict the DC decision were useful. These sensitive variables can be used as a referential guideline in our daily practice to decide to perform or avoid primary DC.

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“…Experience during Operation Iraqi Freedom has indicated that decompressive craniectomy can offer an invaluable surgical technique for controlling intracranial pressure (ICP) or impending brainstem compression. [17][18][19][20][21] Decompressive craniectomy has been used in civilian GWH and seems to be of value when there is extensive hemispheric swelling that is not responsive to maximum medical management. 21 In several studies, patients underwent debridement and decompressive craniectomy.…”

Section: Surgical Managementmentioning

confidence: 99%

Civilian gunshot wounds to the head: a case report, clinical management, and literature review

2020

Preprint

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Background: Civilian gunshot wounds to the head refer to brain injury caused by projectiles such as gun projectiles and various fragments generated by explosives in a power launch or explosion. Gunshot wounds to the head are the deadliest of all gun injuries. According to literature statistics, the survival rate of patients with gunshot wounds to the head is only 9%. Due to the strict management of various types of firearms, they rarely occur, so the injury mechanism, injury and trauma analysis, clinical management, and surgical standards are almost entirely based on military experience, and there are few related reports, especially of the head, in which an individual suffered a fatal blow more than once in a short time. We report a case with a return to almost complete recovery despite the patient suffering two gunshot injuries to the head in a short period of time.Case Presentations: We present a case of a 53-year old man who suffered two gunshot injuries to the head under unknown circumstances. On initial presentation, the patient had a Glasgow Coma Scale score of 6, was unable to communicate, and had loss of consciousness. The first bullet penetrated the right frontal area and finally reached the right occipital lobe. When the patient reflexively shielded his head with his hand, the second bullet passed through the patient's right palm bone, entered the right frontotemporal area, and came to rest deep in the lateral sulcus. The patient had a cerebral hernia when he was admitted to the hospital and immediately entered the operating room for rescue after a computed tomography scan. After two foreign body removals and skull repair, the patient recovered completely.Conclusions: Gunshot wounds to the head have a high mortality rate and usually require aggressive management. Evaluation of most gunshot injuries requires extremely fast imaging examination upon arrival at the hospital, followed by proactive treatment against infection, seizure, and increased intracranial pressure. Surgical intervention is usually necessary, and its key points include the timing, method, and scope of the operation.

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Decompressive craniectomy for the treatment of high intracranial pressure in closed traumatic brain injury

Abstract: Decompressive craniectomy for the treatment of high intracranial pressure in closed traumatic brain injury.

Cited by 87 publications

References 207 publications

Decompressive Craniectomy for Traumatic Brain Injury: In-hospital Mortality-Associated Factors

Decompressive Craniectomy for Traumatic Brain Injury: In-hospital Mortality-Associated Factors

Effect of primary decompressive craniectomy on outcomes in severe traumatic brain injury with mass lesions and the independent predictors for operation decision

Civilian gunshot wounds to the head: a case report, clinical management, and literature review

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