Decompressive craniectomy in the management of traumatic brain injury: a review of current practice

Mezue, Wilfred C; Ndubuisi, Chika Anele

doi:10.2147/oas.s52742

Cited by 3 publications

(6 citation statements)

References 92 publications

(126 reference statements)

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“…The history of DC for traumatic brain injury is a long and checkered one. 7 Studies conducted for ascertaining the role that DC plays in managing TBI patients have explored two important aspects i.e. (1) Comparing decompressive craniectomy with craniotomy in the management of TBI and (2) Comparing decompressive craniectomy with standard medical care in managing TBI patients.…”

Section: Discussionmentioning

confidence: 99%

“…1 Decompressive craniectomy (DC) is a widely used and well-established procedure for managing patients presenting with traumatic brain injury. [4][5][6][7][8] The procedure, however, still to date remains controversial and the role it plays in managing traumatic brain injury patients is still debated. 2,3,5,[7][8][9][10][11] The procedure initially lost favor with the neurosurgeons after the poor results and very high mortality that showed-up in early studies.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6][7][8] The procedure, however, still to date remains controversial and the role it plays in managing traumatic brain injury patients is still debated. 2,3,5,[7][8][9][10][11] The procedure initially lost favor with the neurosurgeons after the poor results and very high mortality that showed-up in early studies. However, there was a resurgence in interest in DC after promising results showed up in later studies.…”

Section: Introductionmentioning

confidence: 99%

“…However, there was a resurgence in interest in DC after promising results showed up in later studies. 1,7 Studies comparing DC with craniotomy in the management of traumatic brain injury have shown conflicting results with some studies finding DC to be associated with a better outcome and others finding DC to be associated with a worse prognosis. 10,[12][13][14][15] The two large decra and resuscip trial comparing DC with standard medical care in patients suffering from severe traumatic brain injury found that DC leads to more unfavorable outcome compared to standard medical management.…”

Section: Introductionmentioning

confidence: 99%

“…2 Making the procedure more controversial is the perception that even if DC reduces mortality it does so only by increasing the number of patients in the vegetative or severely disabled state, thus again putting into question the rationality of the procedure. 7,[16][17][18][19] This has led to a scenario where a uniform protocol for performing the procedure does not exist and different neurosurgical centers and neurosurgeons have their own preferences and protocols. 4,20 The present study had been designed for assessing the outcome and efficacy of the DC procedures performed in our setup for severe TBI patients.…”

Section: Introductionmentioning

confidence: 99%

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Role of Decompressive Craniectomy in severe Traumatic Brain Injury: An Institutional Experience

Altaf¹

2022

Pak J Neurol Surg

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Objective: The present study was designed to assess the outcome following the Decompressive Craniectomy procedures performed in our setup for patients presenting with severe traumatic brain injury. Materials and Methods: This was a retrospective study wherein the medical records of adult patients that presented with an initial Glasgow Coma Scale (GCS) ? 8 and in whom decompressive craniectomy had been carried out for severe traumatic brain injury were retrospectively analyzed. Patients in whom decompressive craniectomy had been carried out for causes other than trauma and patients with initial GCS ? 9 were excluded from the study. The studied parameters included age, sex, initial GCS, computed tomography (CT) brain diagnosis, and the outcome according to the Glasgow coma outcome scale (GOS). Results: The study included 12 patients, and of these 12 patients operated with Decompressive Craniectomy for severe traumatic brain injury only 2 survived. The mortality was 83.3%. The initial GCS and age were not statistically different between the survivors and the non-survivors. Based on the Glasgow Outcome Scale (GOS) only 1 patient had a good outcome. Overall, an unfavorable outcome based on the GOS score was seen in 91.7% of patients. Conclusion: Our study concludes that Decompressive Craniectomy is associated with high mortality in patients presenting with severe traumatic brain injury and does not seem to offer a better alternative to standard medical management.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Role of Decompressive Craniectomy in severe Traumatic Brain Injury: An Institutional Experience

Altaf¹

2022

Pak J Neurol Surg

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Prediction of early mortality after primary decompressive craniectomy in patients with severe traumatic brain injury

et al. 2021

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Objectives Traumatic brain injury (TBI) is a worldwide major health problem associated with a high rate of morbidity and mortality. Intracranial hypertension following TBI is the main but not the only cause of early mortality. Decompressive craniectomy (DC) is used to decrease the intracranial pressure (ICP) and prevent brain herniation following TBI; however, the clinical outcome after DC for patients with TBI generates continuous debate. Prediction of early mortality after DC will help in making the surgery decision. The aim of this study is to predict early mortality after DC based on the initial clinical and radiological findings. Methods In this study, 104 patients with severe traumatic brain injury have been treated by decompressive craniectomy and were retrospectively analyzed. Patients were divided into two groups; group I involved 32 patients who died within 28 days while group II involved 72 patients who survived after 28 days. The relationship between initial Glasgow Coma Scale score (GCS), pupil size and reactivity, associated injuries, and radiological findings were analyzed as predictor factors for early mortality. Results A total of 104 patients with severe TBI have been treated by DC and were analyzed; the early mortality occurred in 32 patients, 30.77%. There is a significant difference between groups in gender, mean GCS, Marshall scale, presence of isochoric pupils, and lung injury. After stratification, odds of early mortality increases with the lower GCS, higher Marshall scale, lung injury, and abdominal injury while male gender and the presence of isochoric pupils decrease the odds of mortality. After univariate regression, the significant impact of GCS disappears except for GCS-8 which decreases the odds of mortality in comparison to other GCS scores while higher Marshall scale, presence of isochoric pupils, and lung injury increase the odds of mortality, but most of these effects disappear after multiple regressions except for lung injury and isochoric pupils. Conclusion Prediction of early mortality after DC is multifactorial, but the odds of early mortality after decompressive craniectomy in severe traumatic brain injury are progressively increased with the lower GCS, higher Marshall scale, and the presence of lung or abdominal injury.

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Decompressive Craniectomy and Cranioplasty: A Review of the Literature on Evolution, Indications, Surgical Techniques, and Complications

Sinha¹,

Siripurapu²,

Herwadkar³

2021

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Decompressive craniectomy refers to removal of a portion of the skull without subsequent replacement, and cranioplasty involves subsequent repair of the skull vault defect. Over the past 3 decades, there has been considerable interest in the use of decompressive craniectomy as part of a second-level measure in the management of refractory raised intracranial pressure. Raised intracranial pressure can be secondary to various causes, including severe head injury, subarachnoid hemorrhage, infection, and acute ischemia. Although the procedure is thought to be effective, several factors should be taken into consideration, including patient selection, optimal time for intervention, risk of associated complications, and patient outcomes. After a craniectomy, patients may subsequently undergo cranioplasty for various reasons, including cosmetic improvement, protection of brain tissue, and as treatment for syndrome of the trephined. Several different materials have been trialed over the years, including biologic and nonbiologic substitutions. Perioperative imaging evaluation plays an important role in the management and follow-up of these patients. The focus of this article is on the expected radiologic appearances in the perioperative period as well as the complications that may arise. Surgical techniques, cranioplasty materials, and historic evolution of decompressive craniectomy and cranioplasty will also be discussed.Learning Objective: To understand the rationale for decompressive craniectomy and cranioplasty as well as recognize the expected postoperative radiologic appearances and their associated complications.

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Decompressive craniectomy in the management of traumatic brain injury: a review of current practice

Cited by 3 publications

References 92 publications

Role of Decompressive Craniectomy in severe Traumatic Brain Injury: An Institutional Experience

Role of Decompressive Craniectomy in severe Traumatic Brain Injury: An Institutional Experience

Prediction of early mortality after primary decompressive craniectomy in patients with severe traumatic brain injury

Decompressive Craniectomy and Cranioplasty: A Review of the Literature on Evolution, Indications, Surgical Techniques, and Complications

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