Early decompressing craniectomy in patients with traumatic brain injury and cerebral edema

Gong, Jiang-Biao; Wen, Liang; Zhan, Ren-Ya; Zhou, Heng-Jun; Wang, Fang; Li, Gu; Yang, Xiao-Feng

doi:10.5372/1905-7415.0801.261

Abstract

Background: Decompressing craniectomy (DC) is an important method for the management of severe traumatic brain injury (TBI).

Objective: To analyze the effect of prophylactic DC within 24 hours after head trauma TBI.

Methods: Seventy-two patients undergoing prophylactic DC for severe TBI were included in this retrospective study. Both of the early and late outcomes were studied and the prognostic factors were analyzed.

Results: In this series, cumulative death in the first 30 days after DC was 26%, and 28 (53%) of 53 survivors in the first month had a good outcomes. The factors including Glasgow Coma Score (GCS) score at admission, whether the patient had an abnormal pupil response and whether the midline shift was greater than 5 mm were most important prognostic factors for the prediction of death in the first 30 days and the final outcome at 6 months after DC.

Conclusion: Prophylactic DC plays an important role in the management of highly elevated ICP, especially when other methods of reduction of ICP are unavailable.

References

1. Maas AI, Dearden M, Teasdale GM, Braakman R, Cohadon F, Iannotti F, et al. EBIC-guidelines for management of severe head injury in adults. European Brain Injury Consortium. Acta Neurochir (Wien). 1997; 139:286-94.10.1007/BF018088239202767
Open DOI Search in Google Scholar Back to article
2. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The joint section on neurotrauma and critical care. Guidelines for cerebral perfusion pressure. J Neurotrauma. 2000; 17:507-11.10.1089/neu.2000.17.50710937893
Search in Google Scholar Back to article
3. Piek J. Decompressive surgery in the treatment of traumatic brain injury. Curr Opin Crit Care. 2002; 8: 134-8.10.1097/00075198-200204000-0000812386514
Open DOI Search in Google Scholar Back to article
4. Timofeev I, Hutchinson PJ. Outcome after surgical decompression of severe traumatic brain injury. Injury. 2006; 37:1125-32.10.1016/j.injury.2006.07.03117081545
Open DOI Search in Google Scholar Back to article
5. Cooper PR, Rovit RL, Ransohoff J. Hemicraniectomy in the treatment of acute subdural hematoma: a reappraisal. Surg Neurol. 1976; 5:25-8.
Search in Google Scholar Back to article
6. Gerl A, Tavan S. Bilateral craniectomy in the treatment of severe traumatic brain edema. Zentralbl Neurochir. 1980; 41:125-38.
Search in Google Scholar Back to article
7. Aarabi B, Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, Eisenberg HM. Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg. 2006; 104:469-79.10.3171/jns.2006.104.4.46916619648
Open DOI Search in Google Scholar Back to article
8. Guerra WK, Gaab MR, Dietz H, Mueller JU, Piek J, Fritsch MJ. Surgical decompression for traumatic brain swelling: indications and results. J Neurosurg. 1999; 90:187-96.10.3171/jns.1999.90.2.01879950487
Open DOI Search in Google Scholar Back to article
9. De Luca GP, Volpin L, Fornezza U, Cervellini P, Zanusso M, Casentini L, et al. The role of decompressive craniectomy in the treatment of uncontrollable posttraumatic intracranial hypertension. Acta Neurochir Suppl. 2000; 76:401-4.10.1007/978-3-7091-6346-7_8311450054
Search in Google Scholar Back to article
10. Yang XF, Wen L, Shen F, Li G, Lou R, Liu WG, et al. Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases. Acta Neurochir (Wien). 2008; 150:1241-7; discussion p. 1248.10.1007/s00701-008-0145-919005615
Open DOI Search in Google Scholar Back to article
11. Wardlaw JM, Easton VJ, Statham P. Which CT features help predict outcome after head injury? J Neurol Neurosurg Psychiatry. 2002; 72:188-92; discussion p. 151.10.1136/jnnp.72.2.188173775511796768
Open DOI Search in Google Scholar Back to article
12. Treggiari MM, Schutz N, Yanez ND, Romand JA. Role of intracranial pressure values and patterns in predicting outcome in traumatic brain injury: a systematic review. Neurocrit Care. 2007; 6:104-12.10.1007/s12028-007-0012-117522793
Open DOI Search in Google Scholar Back to article
13. Huang SJ, Hong WC, Han YY, Chen YS, Wen CS, Tsan YS, et al. Clinical outcome of severe head injury in different protocol-driven therapies. J Clin Neurosci. 2007; 14:449-54.10.1016/j.jocn.2005.12.01217336527
Open DOI Search in Google Scholar Back to article
14. Stocchetti N, Zanaboni C, Colombo A, Citerio G, Beretta L, Ghisoni L, et al. Refractory intracranial hypertension and “second-tier” therapies in traumatic brain injury. Intensive Care Med. 2008; 34:461-7.10.1007/s00134-007-0948-918066523
Search in Google Scholar Back to article
15. Chibbaro S, Tacconi L. Role of decompressive craniectomy in the management of severe head injury with refractory cerebral edema and intractable intracranial pressure. Our experience with 48 cases. Surg Neurol. 2007; 68:632-8.10.1016/j.surneu.2006.12.04617765952
Open DOI Search in Google Scholar Back to article
16. Coplin WM, Cullen NK, Policherla PN, Vinas FC, Wilseck JM, Zafonte RD, et al. Safety and feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traumatic brain injury. J Trauma. 2001; 50:1050-9. 10.1097/00005373-200106000-0001311426120
Open DOI Search in Google Scholar Back to article

Early decompressing craniectomy in patients with traumatic brain injury and cerebral edema

Abstract

Paradigm

My account