-Decompressive craniotomy (DC) is applied to treat post-traumatic intracranial hypertension (ICH).The purpose of this study is to identify prognostic factors and complications of unilateral DC. Eighty-nine patients submited to unilateral DC were retrospectively analyzed over a period of 30 months. Qui square independent test and Fisher test were used to identify prognostic factors. The majority of patients were male (87%). Traffic accidents had occurred in 47% of the cases. 64% of the patients had suffered severe head injury, while pupillary abnormalities were already present in 34%. Brain swelling plus acute subdural hematoma were the most common tomographic findings (64%). Complications occurred in 34.8% of the patients: subdural effusions in 10 (11.2%), hydrocephalus in 7 (7.9%) and infection in 14 (15.7%). The admittance Glasgow coma scale was a statistically significant predictor of outcome ( p=0.0309).KEY WORDS: head injury, intracranial hypertension, decompressive craniotomy. Craniotomia descompressiva: análise de fatores prognósticos e complicações em 89 pacientesResumo -A craniotomia descompressiva (CD) é técnica utilizada para tratamento da hipertensão intracraniana (HIC) pós-traumática. O objetivo do estudo foi determinar fatores prognósticos e complicações nos pacientes submetidos a esta técnica. Realizou-se estudo retrospectivo de 89 pacientes submetidos à CD unilateral para tratamento da HIC pós-traumática durante 30 meses. Utilizou-se testes do Qui-quadrado de independência e teste exato de Fisher para análise de fatores independentes de prognóstico. A maioria dos pacientes era do sexo masculino (87%). A causa mais comum foi o acidente de trânsito (47%). A maioria apresentava traumatismo cranioencefálico grave (64%), 34% já apresentavam anisocoria. O achado tomográfico mais comum foi a associação entre tumefação cerebral e hematoma subdural agudo (64%). Em 34,8% dos pacientes houve complicações inerentes à técnica: coleção subdural (11,2%), hidrocefalia (7,9%) e infecção (15,7%). A escala de coma de Glasgow à admissão correlacionou-se estatisticamente como fator prognóstico (p=0,0309). Decompressive craniotomy (DC) is a surgical method performed to immediately reduce intracranial pressure (ICP). It is usually indicated in cases of brain swelling (BS) and acute subdural hematoma (ASDH), or even for nontraumautic lesions in order to accommodate the swollen brain 1 . It consists of a unilateral craniotomy and dural augmentation. The bone can be temporarily stored in the abdominal subcutaneous tissue or can be disposed in case of a subsequent cranioplasty (with methylmethacrylate or titanium plate, among other materials). PALAVRAS-CHAVERecent studies have been evaluating DC efficacy when performed early in patients with severe traumatic brain injury (TBI) and with intracranial hypertension (ICH), yielding a superior result as compared to late performance or to specific clinical procedures (barbiturate coma and hypothermia) [2][3][4][5][6] . The purpose of this study was to evaluate prognostic...
Background:Craniotomies involving the midline are regular practice in neurosurgery, during which injury to the superior sagittal sinus (SSS), an uncommon yet devastating event, may occur. The midline tends to be the most common landmark used to identify the position of the SSS. In this study we examined the reliability of the midline as a landmark for the SSS.Methods:We performed bilateral craniectomies on eight cadaveric heads, preserving the coronal, sagittal, and lambdoid sutures. The width of the SSS and its displacement from midline were measured on the cadaveric specimens and on 105 normal magnetic resonance images (MRIs) of the head at the following locations: halfway between nasion and bregma (NB), bregma (B), halfway between bregma and lambda (BL), lambda (L), and inion (I).Results:In all cadaveric specimens, the SSS was partially or totally displaced toward one side of midline, usually to the right. It tended to be closer to midline in the frontal region and more displaced posteriorly. The SSS usually drained into the right-side transverse sinus. The mean width of the SSS was 4.3, 5.9, 6.9, 7.9, and 7.8 mm, and the average displacement from midline was 4.3, 6.3, 5.5, 6.9, and 6.0 mm for NB, B, BL, L, and I, respectively. These measurements were then compared with those obtained from the MRIs.Conclusion:The SSS was consistently displaced on either side of midline. Thus, the midline is not reliable for identifying the SSS, and caution should be used within 6–10 mm on either side of midline.
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