Indication of Decompressive Craniectomy in Traumatic Brain Injury

Česká verzia

Authors: V. Juráň ¹; M. Smrčka ¹; K. Svoboda ¹; P. Fadrus ¹; A. Šprláková ²; R. Gál ³
Authors place of work: Neurochirurgická klinika LF MU a FN Brno, 2Radiodi agnostická klinika LF MU a FN Brno, 3Klinika anesteziologi e, resuscitace a intenzivní medicíny LF MU a FN Brno ¹
Published in the journal: Cesk Slov Neurol N 2009; 72/105(5): 439-445
Category: Original Paper

Summary

Backgrounds:
Decompressive craniectomy (DC) is a type of neurosurgical operation performed for the purpose of radical reduction of intracranial pressure, which enables sufficient cerebral perfusion and prevents from brain ischaemia. In severe traumatic brain injuries (Glasgow Coma Scale 3–8), the indication depends on the clinical status of the patient, findings of CT scans, on intracranial and perfusion pressure and on perioperativefindings.

Aim:
To identify the group of patients which most benefit from DC. To evaluate the significance of intracranial monitoring and level of decrease of intracranial pressure after DC. To summarize the main operation diagnoses and review the area of the performed DC.

Patient group and methods:

The study is based on three-year prospective monitoring of 81 patients undergoing DC after severe brain injury in 2003–2005. Control group was formed by 68 retrospectively analyzed patients who had undergone DC in the years 1996–1998. In both groups we analyzed age, sex, anamnesis, operative diagnosis, performed monitoring, timing of the operation, localization and the area of DC, GCS at the time of indication of DC and GOS 12 months after injury.

Results:
The group of patients younger than 50 years of age had good recovery (GOS 4–5) in 45% of cases and if these patients had even ICP monitoring, good recovery was present in 70% of cases, which was statistically significant (α < 0.05). After DC there was a statistically significant reduction in intracranial pressure from a mean of 31.8 mmHg to 9.2 mmHg 2 hours after the operation, and 11.0 mmHg 24 hours after the operation (p < 0.01), respectively. Most frequent operative diagnoses were: acute subdural haematoma in 56% of cases, and cerebral contusion in 25% of cases. Mean area of performed DC was 157 cm².

Conclusion:
Good recovery in patients with severe traumatic brain injury is conditioned by early indication of DC according to ICP monitoring, by age under 50 years, and by performing sufficiently large decompression.

Key words:
decompressive craniectomy – traumatic brain injury – indicati on – monitoring

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