Prognosis for Severe Traumatic Brain Injury Patients Treated with Bilateral Decompressive Craniectomy
Decompressive craniectomy for traumatic brain injury patients has been shown to reduce intracranial hypertension, while it often results in increased brain edema and/or contralateral space-occupied hematoma. The purpose of this study was to determine the
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Abstract Purpose Decompressive craniectomy for traumatic brain injury patients has been shown to reduce intracranial hypertension, while it often results in increased brain edema and/or contralateral space-occupied hematoma. The purpose of this study was to determine the prognosis of bilateral decompressive craniectomy in severe head injury patients with the development of either bilateral or contralateral lesions after ipsilateral decompressive craniectomy. Methods Twelve patients underwent bilateral decompressive craniectomy among 217 individuals who had been treated with decompressive craniectomy with dural expansion from September 1995 to August 2006. The following patient data were retrospectively collected: age, neurological status at admission, time between injury and surgical decompression, time between first and second decompression, laboratory and physiological data collected in the intensive care unit, and outcome according to the Glasgow Outcome Scale. Results Patient outcomes fell into the following categories: good recovery (three patients); mild disability (one patient); severe disability (two patients); persistent vegetative state (one patient); and death (five patients). Patients with good outcomes were younger and had better pupil reactions and neurological statuses on admission. Other factors existing prior to the operation did not directly correlate with outcome. At 24 h post-surgery, the average intercranial pressure (ICP), cerebral perfusion pressure (CPP), glucose level, and lactate level in patients with poor outcomes differed significantly from those of patients with a good prognosis. H. Yatsushige (), Y. Takasato, H. Masaoka, T. Hayakawa, N. Otani, Y. Yoshino, K. Sumiyoshi, T. Sugawara, H. Miyawaki, C. Aoyagi, S. Takeuchi, and G. Suzuki Department of Neurosurgery, National Hospital Organization Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo, Japan e-mail: [email protected]
Conclusion Head injury patients with either bilateral or contralateral lesions have poor prognosis. However, bilateral decompressive craniectomy may be a favorable treatment in certain younger patients with reactive pupils, whose ICP and CPP values are stabilized 24 h post-surgery. Keywords Decompressive craniectomy • bilateral lesion • head injury • intracranial pressure • cerebral perfusion pressure
Introduction Significant efforts have been made to control brain swelling caused by serious head injury. Decompressive craniectomy, one modality for head trauma, has been practiced since the early nineteenth century (5). Previous studies (10,14) have demonstrated that decompressive craniectomy provides a reduction in intracranial hypertension, and that surgical decompression is superior to medical management in patients with massive brain swelling. However, others (16) have reported increases in either brain edema or contralateral space-occupied hematoma after decompressive craniectomy (7,8), leading to the skepticism with respect to the usefulness of this procedure. At the National Hospital Organi
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