Decompressive craniectomy in traumatic brain injury: A single-center, multivariate analysis of 1,236 patients at a tertiary care hospital in India

Sinha, Sumit; Raheja, Amol; Garg, Mayank; Moorthy, Skanda; Agrawal, Deepak; Gupta, Deepak; Satyarthee, Guru Dutta; Singh, Pankaj Kumar; Borkar, Sachin A; Gurjar, Hitesh; Tandon, Vivek; Pandey, Ravindra Mohan; Sharma, Bhawani S.

doi:10.4103/0028-3886.156277

Cited by 33 publications

(30 citation statements)

References 24 publications

(38 reference statements)

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“…The relative increase in the use of this procedure and the improvement in the survival rate have led to a growing number of patients who might need a cranioplasty. [1][2][3][4][5] Classically, the benefits of a cranioplasty were primarily to protect the brain and repair cosmetic defects. However, there are an increasing number of publications suggesting that cranioplasties may result in neurological improvement via increased cerebral blood flow (CBF), and an improvement of cerebrospinal fluid (CSF) dynamics and cerebral metabolism.…”

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confidence: 99%

The Effect of Cranioplasty on Cerebral Hemodynamics as Measured by Perfusion Computed Tomography and Doppler Ultrasonography

Paredes

Castaño

Cepeda

et al. 2016

Journal of Neurotrauma

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Cranioplasties are performed to protect the brain and correct cosmetic defects, but there is growing evidence that this procedure may result in neurological improvement. We prospectively studied cranioplasties performed at our hospital over a 5-year period. The National Institute of Health Stroke Scale and Barthel index were recorded prior to and within 72 h after the cranioplasty. A perfusion computed tomography (PCT) and transcranial Doppler sonography (TCDS) were performed prior to and 72 h after the surgery. For the PCT, regions irrigated by the anterior cerebral artery, the middle cerebral artery (MCA), the posterior cerebral artery, and the basal ganglia were selected, as well as the mean values for the hemisphere. The sonography was performed in the sitting and the supine position for the MCA and internal carotid. The velocities, pulsatility index, resistance index, and Lindegaard ratio (LR) were obtained, as well as a variation value for the LR (DLR = LR sitting -LR supine). Fifty-four patients were included in the study. Of these, 23 (42.6%) patients presented with objective improvement. The mean cerebral blood flow of the defective side (m-CBF-d) increased from 101.86 to 117.17 mL/100 g/min ( p = 0.064), and the m-CBF of the healthy side (m-CBF-h) increased from 128.14 to 145.73 mL/100 g/min ( p = 0.028). With regard to the TCDS, the DLR was greater on the defective side prior the surgery in those patients who showed improvement (1.295 vs. -0.714; p = 0.002). Cranioplasty resulted in clinical improvement in 40% of the patients, with an increase in the post-surgical CBF. The larger variations in the LR when the patient is moved from the sitting to the supine position might predict the clinical improvement.

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confidence: 99%

The Effect of Cranioplasty on Cerebral Hemodynamics as Measured by Perfusion Computed Tomography and Doppler Ultrasonography

Paredes

Castaño

Cepeda

et al. 2016

Journal of Neurotrauma

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“…12 In our study, it is found that male to female ratio was 3.8:1 with 79.46% males and 20.53% females and it is also comparable to other studies. 6,[13][14][15] Males in the age group of 19 to 40 years are more affected than females with a ratio of Abbreviation: CSF, cerebrospinal fluid; PCA, posterior cerebral artery; MCA, middle cerebral artery.…”

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confidence: 99%

Prognostic Predictors of Decompressive Craniectomy in Traumatic Brain Injury: A Clinical Experience of 128 Cases

Nath

Dhir

Mishra

et al. 2016

IJNT

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Objectives?The objective of this study was to analyze different parameters such as clinicoradiological presentation, surgical outcome, and factors associated with prognosis of traumatic brain injury patients undergoing decompressive craniectomy (DC). Materials and Methods?This observational study was done on all the cases of DC undertaken in our hospital during July 2013 to June 2015. In all cases, the age, sex, mode of injury, severity of injury, associated injuries, indications, computed tomography (CT) finding, complications, and outcomes in the form of morbidity and mortality were analyzed. Results?Out of all head injury patients admitted, only 3.036% underwent DC. The most common age group affected was 19 to 40 years (n?=?49; 43.75%; p-value??40 years, male sex, alcoholics, pupillary dilation, and aspiration pneumonia are the independent factors for increased mortality and disability.

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“…Low and middle income countries like India constitute 90% of the burden of traumatic brain injury (TBI). Without insurance or state sponsored specialised care, the cost of the treatment is borne by the patient's family (5).…”

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confidence: 99%

Customised cranioplasty implant for decompressive craniectomy patients –a technical note

Kaif

2017

Turkish Neurosurgery

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Cranioplasty is a commonly performed procedure following decompressive craniectomy. The patients are usually young earning persons and increasing cost of treatment is difficult to bear especially in low and middle income countries. A variety of options are available for cranioplasty ranging from autologus bone graft to xenograft and synthetic materials. Presently the autologous cryopreserved or subcutaneously preserved bone graft is considered as preferred choice but is has its drawback of bone resorption and infection . Custom made titanium implants and Polyetheretherketone (PEEK) implants using 3D printing technologies are also being used but its use is limited because of its high cost and lack of availability of this these technologies in the developing world which have maximum number of such cases. The authors present an easy and low cost technique for making customised cranioplasty implant by Polymethylmethacrylate (PMMA) using the craniotomy bone flap of the patient as a template.

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Decompressive craniectomy in traumatic brain injury: A single-center, multivariate analysis of 1,236 patients at a tertiary care hospital in India

Cited by 33 publications

References 24 publications

The Effect of Cranioplasty on Cerebral Hemodynamics as Measured by Perfusion Computed Tomography and Doppler Ultrasonography

The Effect of Cranioplasty on Cerebral Hemodynamics as Measured by Perfusion Computed Tomography and Doppler Ultrasonography

Prognostic Predictors of Decompressive Craniectomy in Traumatic Brain Injury: A Clinical Experience of 128 Cases

Customised cranioplasty implant for decompressive craniectomy patients –a technical note

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