Craniotomia descompressiva no edema cerebral grave: a propósito de 30 casos operados

Abstract

Uni or bilateral decompressive craniotomy was carried out in 30 patients bearing severe cerebral edema of etiology predominantly traumatic. Coma, midriasis and decerebrate state were the mostly commonly clinical features presented. The average survival in the series was 46.6%.

Cerebral hemodynamic changes gauged by transcranial Doppler ultrasonography in patients with posttraumatic brain swelling treated by surgical decompression

“…When nonsurgical management fails to control ICP and cerebral herniation, decompressive craniectomy may be indicated as a last resort. 4,7,13 Despite many publications on the subject, 2,6,9,12,14,17,24,34,36,39,43,44,49,52,55 the actual benefit of this treatment modality on neurological outcome in patients remains unknown. The hemodynamic changes in the brain in response to decompressive craniectomy have not been systematically studied in patients with traumatic brain swelling.…”

Surgical decompression for traumatic brain swelling: indications and results

“…12 Good results with this technique were reported by Heppner and associates, 30 Alexander, et al, 1 and Gower, et al, 25 even though this form of trephination faces the risk of temporal lobe herniation and necrosis. 36 Bifrontal craniectomy was performed with good results by Pereira, et al, 49 and Polin, et al 52 Venes and Collins, 66 Goncalves da Silva and associates, 24 and Kjellberg and Prieto 38 had less convincing results. They reported a decrease in the incidence of mortality at the price of an increase in that of morbidity after the procedure.…”

Lesão cerebral penetrante por grande fragmento de fibra de amianto tratada por craniectomia descompressiva: relato de caso

“…Acreditamos que a pronta indicação de craniectomia descompressiva após evidências tomográ-ficas de tumefação cerebral e conseqüente hipertensão intracraniana possibilitou a manutenção da PIC em valores fisiológicos, favorecendo a perfusão cerebral e prevenindo injúria secundária [23][24][25][26][27][28][29] . Outrossim, a permanência em unidade de tratamento intensivo no período pós-operatório otimizou as medidas citadas, como controle da PIC e manutenção da PPC, além de permitir o tratamento adequado e em tempo hábil de complicações como instabilidade hemodinâmica e meningite [30][31][32][33] .…”