Unilateral Decompressive Craniectomy in Traumatic Brain Injury Patients with Poor Glasgow Coma Scale as an Intraoperative Decision after Evacuation of Focal Lesion; Outcome in 30 Consecutive Cases
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- Category: Vol. 80, March 2012
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Unilateral Decompressive Craniectomy in Traumatic Brain Injury Patients with Poor Glasgow Coma Scale as an Intraoperative Decision after Evacuation of Focal Lesion; Outcome in 30 Consecutive Cases, AHMED M. KERSH and HANAN H. EL-GENDY
Abstract
Objective: Assessment of the outcome and its predictors after decompressive craniectomy (DC) in traumatic brain injury (TBI) after evacuation of focal lesion and comparison the results to other studies in which the focal lesion evacuated without DC.
Methods: A total number of 30 consecutive cases of TBI with immediate evacuation of focal lesion like subdural hematoma (SDH) or extradural hematoma with persistent brain swelling after the evacuation, managed by removal of the bone flap with or without widening of the craniectomy site with durotomy with follow-up the outcome using Glasgow outcome scale (GOS) determining the predictors for outcome and comparison the results of other studies in which the focal lesion evacuated without DC and cranioplasty for the patients when the conscious level improved.
Results: The age ranged from 12-65 years, the mean age in SDH was 50 year and in EDH was 28 year, male to female ratio was 1.7:1, the most common cause of injury was motor car accident, SDH was present in 16 cases (53.33%), EDH in 20 cases (66.67%), both EDH and SDH in 8 cases (26.67%) and intracerebral hematoma (ICH) in 2 cases, skull fracture was present in 20 cases (66.67%), midline shift more than 10mm in 19 cases (63.33%) and less than 10mm in 11 cases (36.67%), 12 cases had good outcome (40%), two cases had moderate disability (6.67%), five cases (16.67%) had severe disability, six cases (20%) became vegetative and five cases (16.67%) mortality, the subdural effusion was the most com-mon complication in (23.33%).
Conclusion: Reduction of morality and morbidity from TBI is the goal of DC. The most important predictors for outcome after DC were GCS and midline shift in CT brain. DC decrease the mortality more in SDH but improve the functional outcome in both SDH and EDH associated with increased intracranial pressure (ICP). The subdural effusion was the most common complication, cranioplasty was more beneficial in syndrome of trephined.