Reimaging in pediatric neurotrauma: Factors associated with progression of intracranial injury

Givner, Andy; Gurney, Jennifer M; O’Connor, Daniel; Kassarjian, Ara; LaMorte, Wayne W.; Moulton, Steve

doi:10.1053/jpsu.2002.30825

Cited by 51 publications

(62 citation statements)

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“…For example, Oertel et al (2002) found, in a retrospective analysis of 142 TBI patients with a median GCS of 8, that 42% had progressive hemorrhages. Similar percentages of hemorrhagic contusion expansion have been reported in other series, including 59% in a series of 37 comatose TBI patients (Servadei et al, 1995), 48% among a series of 104 children with TBI (Givner et al, 2002), 47% among a series of 141 TBI patients with traumatic subarachnoid hemorrhage on the initial CT scan (Chieregato et al, 2005). In two series from our institution, progressive hemorrhages were seen in 38% of 113 TBI patients (Chang et al, 2006) and 42% of 116 TBI patients .…”

Section: Discussionsupporting

confidence: 86%

Post-Operative Expansion of Hemorrhagic Contusions after Unilateral Decompressive Hemicraniectomy in Severe Traumatic Brain Injury

Flint

Manley

Gean

et al. 2008

Journal of Neurotrauma

127

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Decompressive hemicraniectomy is commonly performed in patients with traumatic brain injury (TBI) with diffuse brain swelling or refractory raised intracranial pressure. Expansion of hemorrhagic contusions in TBI patients is common, but its frequency following decompressive hemicraniectomy has not been well established. The aim of this retrospective study was to determine the rate of hemorrhagic contusion expansion following unilateral hemicraniectomy in severe TBI, to identify factors associated with contusion expansion, and to examine whether contusion expansion is associated with worsened clinical outcomes. Computed tomography (CT) scans of 40 consecutive patients with non-penetrating TBI who underwent decompressive hemicraniectomy were analyzed. Hemorrhagic contusion volumes were measured on initial, last pre-operative, and first post-operative CT scans. Mortality and 6-month Glasgow Outcome Scale (GOS) score were recorded. Hemorrhagic contusions of any size were present on the initial head CT scan in 48% of patients, but hemorrhagic contusions with a total volume of >5 cc were present in only 10%. New or expanded hemorrhagic contusions of >or=5 cc were observed after hemicraniectomy in 58% of patients. The mean volume of increased hemorrhage among these patients was 37.1+/-36.3 cc. The Rotterdam CT score on the initial head CT was strongly associated with the occurrence and the total volume of expanded hemorrhagic contusions following decompressive hemicraniectomy. Expanded hemorrhagic contusion volume greater than 20 cc after hemicraniectomy was strongly associated with mortality and poor 6-month GOS even after controlling for age and initial Glasgow Coma Scale (GCS) score. Expansion of hemorrhagic contusions is common after decompressive hemicraniectomy following severe TBI. The volume of hemorrhagic contusion expansion following hemicraniectomy is strongly associated with mortality and poor outcome. Severity of initial CT findings may predict the risk of contusion expansion following hemicraniectomy, thereby identifying a subgroup of patients who might benefit from therapies aimed at augmenting the coagulation system.

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Section: Discussionsupporting

confidence: 86%

Post-Operative Expansion of Hemorrhagic Contusions after Unilateral Decompressive Hemicraniectomy in Severe Traumatic Brain Injury

Flint

Manley

Gean

et al. 2008

Journal of Neurotrauma

127

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“…Some authors feel that it is not necessary to repeat HCT in patients who do not experience any clinical event, in that they have not found any changes in the management of these patients [16], whereas others found an improvement in management after a second HCT [17]. In our study, there were 10 patients with initial GCS less than 9 and an early initial HCT (average, 2.5 hours) that was normal.…”

Section: Discussionmentioning

confidence: 50%

Severe head injury among children: computed tomography evaluation as a prognostic factor

Teruel¹,

Rico²,

Lasaosa³

et al. 2007

Journal of Pediatric Surgery

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“…Hemorrhagic expansion of contusions is inherent in the injury process and has been demonstrated on serial CT scanning in patients with TBI. 10,58,79 Hemorrhagic contusion expansion was observed in 42% of 142 TBI patients with median GCS scores of 8, 58 59% of 37 patients in a coma, 77 48% of 104 children with TBI, 28 and 47% of 141 patients with TBI presenting with traumatic subarachnoid hemorrhage on their CT scan. 12 Experimental animal models of controlled cortical impact have demonstrated that craniectomy, compared with craniotomy, reduces contusion volume by 40%.…”

Section: Perioperative Complicationsmentioning

confidence: 99%

Complications of decompressive craniectomy for traumatic brain injury

Stiver¹

2009

FOC

383

302

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Decompressive craniectomy is widely used to treat intracranial hypertension following traumatic brain injury (TBI). Two randomized trials are currently underway to further evaluate the effectiveness of decompressive craniectomy for TBI. Complications of this procedure have major ramifications on the risk-benefit balance in decision-making during evaluation of potential surgical candidates. To further evaluate the complications of decompressive craniectomy, a review of the literature was performed following a detailed search of PubMed between 1980 and 2009. The author restricted her study to literature pertaining to decompressive craniectomy for patients with TBI. An understanding of the pathophysiological events that accompany removal of a large piece of skull bone provides a foundation for understanding many of the complications associated with decompressive craniectomy. The author determined that decompressive craniectomy is not a simple, straightforward operation without adverse effects. Rather, numerous complications may arise, and they do so in a sequential fashion at specific time points following surgical decompression. Expansion of contusions, new subdural and epidural hematomas contralateral to the decompressed hemisphere, and external cerebral herniation typify the early perioperative complications of decompressive craniectomy for TBI. Within the 1st week following decompression, CSF circulation derangements manifest commonly as subdural hygromas. Paradoxical herniation following lumbar puncture in the setting of a large skull defect is a rare, potentially fatal complication that can be prevented and treated if recognized early. During the later phases of recovery, patients may develop a new cognitive, neurological, or psychological deficit termed syndrome of the trephined. In the longer term, a persistent vegetative state is the most devastating of outcomes of decompressive craniectomy. The risk of complications following decompressive craniectomy is weighed against the life-threatening circumstances under which this surgery is performed. Ongoing trials will define whether this balance supports surgical decompression as a first-line treatment for TBI.

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Reimaging in pediatric neurotrauma: Factors associated with progression of intracranial injury

Cited by 51 publications

References 0 publications

Post-Operative Expansion of Hemorrhagic Contusions after Unilateral Decompressive Hemicraniectomy in Severe Traumatic Brain Injury

Post-Operative Expansion of Hemorrhagic Contusions after Unilateral Decompressive Hemicraniectomy in Severe Traumatic Brain Injury

Severe head injury among children: computed tomography evaluation as a prognostic factor

Complications of decompressive craniectomy for traumatic brain injury

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