Outcome of Patients with Severe Head Injury After Decompressive Craniectomy
Decompressive craniectomy is an operative option for the neurosurgeon in cases of generalized traumatic brain edema. While the outcome of patients after decompressive craniectomy is often poor, we tried to identify predictors of a favorable course of the
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Abstract Decompressive craniectomy is an operative option for the neurosurgeon in cases of generalized traumatic brain edema. While the outcome of patients after decompressive craniectomy is often poor, we tried to identify predictors of a favorable course of the injury. Therefore, 131 patients who received a decompressive craniectomy at the Unfallkrankenhaus Berlin (ukb) between September 1997 and September 2005 due to severe traumatic brain injury were followed up. Overall outcome was measured using the Glasgow Outcome Scale (GOS). Sixty-three patients (48%) died during their initial hospital stay and another 27 (21%) were discharged in a vegetative state (GOS 2). Thirty-two patients (24%) were discharged with severe disability, while another nine (7%) had moderate disability at discharge. At an average of 49 months after surgery, 75 patients (68%) were either dead or in a vegetative state (GOS 1 and 2). The results stress again that the prognosis after traumatic brain injury (TBI) with decompressive craniectomy (DC) is unfavorable. Age, midline shift, and status of the basal cisterns on cranial computed tomography (cCT) were associated with the long-term outcome. When weighing whether to initiate the last resort intervention of decompressive craniectomy, the predictive factors detailed here should be taken into consideration.
resort – in terms of operative therapy. The decision for or against this measure depends largely on the prognostic indications of the individual patient. The goal of our study was to determine if factors exist that can reliably predict the quality of outcome in these patients.
Patients and Methods All 131 patients who underwent decompressive craniectomy for severe head injury in our department between September 1997 and September 2005 were included in this partially prospective study. Their clinical records were prospectively evaluated and a number of preoperative factors were recorded. These included basic epidemiological information as well as the Glasgow Coma Scale (GCS) score on admission, the initial cCT scan results, pupil reactivity on admission, and the position of the midline on cCT on admission. A retrospective follow-up examination was conducted at least 12 months after discharge from the Unfallkrankenhaus Berlin, in which the condition of the patient was determined using the Glasgow Outcome Scale (GOS).
Keywords Severe head injury • decompressive craniectomy • outcomes • predictive factors
Results Introduction Primary brain injury in severe head trauma occurs at the moment of the mechanical insult. With this in mind, the neurosurgeon must decide how to intervene therapeutically in order to at least minimize secondary brain injury. Decompressive craniectomy represents the neurosurgeon’s ultima ratio – last U. Meier (*), J. Lemcke, S. Ahmadi Department of Neurosurgery, Unfallkrankenhaus Berlin, Warener Straße 7, Berlin D-12683, Germany e-mail: [email protected]
The mean age of the 99 men (76%) and 32 (24%) women was 36 ± 20 years at the time of the operation. The commo
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