Outcome of decompressive craniectomy in traumatic closed head injury

Laghari, Altaf Ali; Bari, Ehsan; Waqas, Muhammad; Ahmed, Syed Ijlal; Nathani, Karim Rizwan; Moazzam, Wardah

doi:10.4103/ajns.ajns_195_17

Cited by 9 publications

(13 citation statements)

References 25 publications

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“…Comparative to our study many studies report, younger age as a determinant of favorable outcomes than the older age, though the age cut off limits are heterogeneous among studies [12][13][14]. Similarly, good pupillary reaction is a significant predictor of favorable outcomes in our study as well in other published studies [10,14,15].…”

Section: Discussionsupporting

confidence: 51%

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Decompressive craniectomy for traumatic brain injury: outcomes and their determinants

2021

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Background Decompressive craniectomy (DC) is a management option to control raised intracranial pressure (ICP) in traumatic brain injury (TBI) with inconsistent evidence for its outcomes and their determinants.Objectives The aim of this study was to assess the outcomes and determinants of outcomes of DC done in National Hospital of Sri Lanka (NHSL) at one year and three years of follow-up. Materials and methodsPatients who underwent DC for TBI within 6 months period from 01/02/2016 to 31/07/ 2016 at the Neurotrauma Centre, NHSL were included in the study. Data were retrieved from medical records. Outcomes were evaluated by interviewing patients/ relatives over the telephone using standard questionnaire for extended Glasgow Outcome scale (GOS-E).Results Inclusion and exclusion criteria matched 118 patients were selected and 89 (75.42%) contactable patients were included in the analysis. Majority (86.4%) were males and median age was 45 years. There were 56 primary DCs and 33 secondary DCs. Favorable outcomes (GOS-E 5-8) were seen in 20.2% and in 24.7% at the end of one year and three years respectively. Younger age, good pupillary reaction and higher GCS on admission were associated with statistically significant favorable outcomes (P<0.05). Pupillary symmetry, timing of DC (primary or secondary), time elapsed from time of injury to performing primary DC, type of DC, whether CT shows an isolated lesion or multiple lesions, submission to tracheostomy, having medical comorbidities and postoperative infections were not predictive of the outcome. Conclusion Favorable functional outcomes following DCfor TBI is limited to 20-25%. Younger age, good pupillary reaction and higher GCS are predictors of favorable functional outcomes.

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Section: Discussionsupporting

confidence: 51%

“…Performing tracheostomy has not shown any association on outcome in our study. However Laghari et al has reported tracheostomy as a negative predictor of good functional outcome [13]. Saade et al has reported that having multiple lesions on CT results in poor outcomes compared to presence of a single lesion [10].…”

Section: Discussionmentioning

confidence: 99%

Decompressive craniectomy for traumatic brain injury: outcomes and their determinants

2021

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“… 13 16 22 23 24 Unfavorable outcomes reported were low-GCS scores on admission, postoperative hydrocephalus, tracheostomy, sphenoid fractures, and unchanged ICP. 21 25 26 …”

Section: Discussionmentioning

confidence: 99%

“…DC-relatedmortality rates ranged from 12 to 55%. 16 20 21 22 24 25 26 27 In-hospital mortality rates ranged between 32 to 55%, 20 21 26 whereas 30-day mortality rates ranged from 12 to 28.3%. 16 22 24 27 Laghari et al reported an in-hospital mortality rate of 25% at 3 months in their series.…”

Section: Discussionmentioning

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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“…1 The mortality and morbidity are high and the percentage of patients that either die or survive with severe disability following severe traumatic brain injury is approximately 60%. 2,3 The mortality and morbidity remains very high even in the USA and Europe and even in centers that specialize in neurotrauma management and reaches upto atleast 50% even in such specialized neurotrauma centers. 1 The burden of severe traumatic brain injury is biggest in low and middle-income countries.…”

Section: Introductionmentioning

confidence: 99%

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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Outcome of decompressive craniectomy in traumatic closed head injury

Cited by 9 publications

References 25 publications

Decompressive craniectomy for traumatic brain injury: outcomes and their determinants

Decompressive craniectomy for traumatic brain injury: outcomes and their determinants

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

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

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