Role of Decompressive Surgery in the Management of Severe Head Injuries: Prognostic Factors and Patient Selection

Abstract

Decompressive surgery or craniectomy (DC) is a treatment option, which should be considered when the intracranial pressure (ICP) cannot be treated by conservative methods. The purpose of this study was to evaluate the benefits of decompressive craniectomy in patients with intractable posttraumatic intracranial hypertension and to evaluate the patient selection criteria for this management protocol. In this study, 100 patients with severe head injuries were involved. All patients were treated according to the European Brain Injury Consortium (EBIC) guidelines for severe head injuries and were assessed based on individual initial Glasgow Coma Scores (GCS), age, Glasgow Outcome Score (GOS), presence of systemic injury, changes in ICP, presence of mass lesion and the right timing for DC. All patients presented with a GCS of 8 or below. Based on their initial GCS, the patients were divided in two groups of 60 (group I with GCS 4-5) and 40 (group II with GCS 6-8) in each, respectively. Prognosis was evaluated according to the (GOS). After treatment with DC, 84 of the patients (84%) showed unfavorable and 16 (16%) showed favorable outcomes. In group I, 58 patients (96.6%) showed unfavorable and two (3.4%) showed favorable outcomes. In group II, 26 (65%) patients showed unfavorable and 14 (25%) showed favorable outcomes. The importance of initial GCS and age in patient outcomes were statistically significant. The presence of systemic injuries or mass lesions in outcomes were not statistically significant. Based on our findings, we conclude that patients with Glasgow Coma Scores of 6-8 are the best candidates for DC treatment.

Effects of decompressive surgery in patients with severe traumatic brain injury and bilateral non-reactive dilated pupils

“…In our previous report, we already proposed that this group of patients were the best candidates for DS. [35] They also presented with neurological deterioration (GCS score of 4 and BNDP) due to mass effect from a hematoma (subdural hematoma in 4 and intracerebral hematoma in 2 patients). Those patients might have a higher chance of survival and functional recovery than patients whose neurological status is mainly caused by diffuse cerebral swelling.…”

Operative and nonoperative linguistic outcomes in brain injury patients

“…Several findings mirror the unfavorable function outcome after surgery intervention [22][23][24]. On the other side, some researchers inferred craniectomy as an acceptable and practical operative procedure for extracting lesions such as subdural and intercerebral hematoma and intercerebral pressure depression in most brain trauma patients can have favorable outcome if some major factors like age [25][26][27][28], brain injury severity [29], extracranial damage [30], plus brain stem and cortex injuries are taken into account [27,28]. The effect of craniectomy's size on function outcome has also been reported [31].…”

Dynamics of subdural hygroma following decompressive craniectomy: a comparative study

“…1,2,10,11,23,29,47,58,68,70,74 Selecting DC as a second-tier option in the management of severe head injury mandates attention to a frequent complication of this operative procedure, namely the SDG. 1,2,34,41,76 In this investigation, we studied the clinical and imaging characteristics of 39 patients with SDGs and compared them with those of 29 patients without to better understand the dynamics of the initial appearance, increase in volume, and resolution of this seemingly benign-looking complication following DC.…”