Decompressive Craniectomy in Traumatic Brain Injury: An Institutional Experience of 131 Cases in Two Years

Abstract

Decompressive craniectomy (DC) effectively reduces intracranial pressure (ICP), but is not considered to be a firstline procedure. We retrospectively analyzed sociodemographic, clinical, and surgical characteristics associated with the prognosis of patients who underwent DC to treat traumatic intracranial hypertension (ICH) at the Restauração Hospital (HR) in Recife, Brazil between 2015 and 2016, and compared the clinical features with surgical timing and functional outcome at discharge. The data were collected from 131 medical records in the hospital database. A significant majority of the patients were young adults (age 18-39 years old; 75/131; 57.3%) and male (118/131; 90.1%). Road traffic accidents, particularly those involving motorcycles (57/131; 44.5%), were the main cause of the traumatic event. At initial evaluation, 63 patients (48.8%) were classified with severe traumatic brain injury (TBI). Pupil examination showed no abnormalities for 91 patients (71.1%), and acute subdural hematoma was the most frequently observed lesion (83/212; 40%). Glasgow Outcome Scale (GOS) score was used to categorize surgical results and 51 patients (38.9%) had an unfavorable outcome. Only the Glasgow Coma Scale (GCS) score on admission (score of 3-8) was more likely to be associated with unfavorable outcome (pvalue = 0.009), indicating that this variable may be a determinant of mortality and prognostic of poor outcome. Patients who underwent an operation sooner after injury, despite having a worse condition on admission, presented with clinical results that were similar to those of patients who underwent surgery 12 h after hospital admission. These results emphasize the importance of early DC for management of severe TBI. This study shows that DC is a common procedure used to manage TBI patients at HR.

Retrospective Review of Bilateral Decompressive Craniectomy of 51 Patients after Severe Traumatic Head Injury

“…Since significantly more traffic accidents involved motorcycles compared to other types of vehicles, motorcycle accidents were analyzed separately from other traffic accidents. These findings are well agreement with other studies Silva et al 2 This study shows 33.4% were moderate traumatic head injury, 58.8% were severe traumatic head injury and 7.8% were critical head injury. Similar study Silva et al 2 reported 23.3% were mild traumatic head injury, 27.9% were traumatic head injury and 48.8% were severe traumatic head injury.…”

“…In this study found majority were male (94.1%) and only 5.9% were female. These findings are well agreement with other studies Silva et al 2 Similar study Shah et al 13 reported 33 (71.7%) were male and 13 (28.3%) were female.…”

“…The average age was 29.70±14.78 years. This finding consistent with Silva et al 2 Similar study Prasad et al 12 reported the mean age was 38.3 years (range 1--68 years).…”

“…1 According to World Health Organization (WHO) estimates, each year around 5.8 million deaths occur worldwide that are due to or associated with traumatic injuries. 2 Traumatic brain injury (TBI) stands out among other injuries for its significant contribution to mortality, disability. 3,4 Severe head trauma can lead to brain swelling, increased intracranial pressure (ICP), reduced cerebral blood flow, inadequate oxygen delivery, ischemia, metabolic failure, and brain edema.…”

“…5 In some cases, hypertension is refractory to first-and second-level therapeutic measures, and requires emergency surgical intervention with decompressive craniectomy (DC). 2 Decompressive craniectomy (DC) has been used for the management of intracranial pressure (ICP) with severe TBI patients as a primary or prophylactic intervention, or as a secondary intervention when firstline therapies fail. 6 Some studies in TBI populations have shown that DC improves ICP and cerebral perfusion pressure (CPP), contributing to improved long-term functional outcomes and reduction in costs.…”