Decompressive Craniectomy in Neurocritical Care

Hayman, Erik; Kurland, David B.; Grunwald, Zachary; Urday, Sebastian; Sheth, Kevin N; Simard, J. Marc

doi:10.1055/s-0036-1592170

Cited by 7 publications

(3 citation statements)

References 145 publications

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“…This supports the idea that adequate monitoring of clinical parameters is equally valuable in the management of head injury. [ 15 16 17 18 19 ] Few other studies from our institute have evaluated Rotterdam score and optic nerve sheath diameter as predictors of functional outcomes and mortality in patients undergoing decompressive craniectomy. [ 20 21 ] Both are noninvasive methods of measuring ICP.…”

Section: Discussionmentioning

confidence: 99%

Outcome of decompressive craniectomy in traumatic closed head injury

et al. 2018

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Objective:The aim of the current study was to observe functional outcomes of patients undergoing decompressive craniectomy (DC) for raised intracranial pressure (ICP) after blunt head injury and to assess possible predictive factors.Methodology:This study was a prospective cohort study which was conducted at Aga Khan University Hospital, Karachi over a period of 2 years (January 2015–December 2016). Adult patients, aged between 15 and 65 years of both genders undergoing DC during the study period were selected. Outcomes of DC were assessed at an interval of 3 months following injury using the Glasgow outcome score. The data were analyzed on IBM statistics SPSS version 21.Results:Seventy-two patients underwent DC for raised and refractory ICP. Glasgow Outcome Scale (GOS) at discharge, 1-month and 3-month follow-up were reported. GOS at 3-month follow-up showed 21 patients (29.2%) patients had a good recovery, moderate disability was reported in 16 patients (22.2%), and severe disability in 12 patients (16.7%), persistent vegetative state was seen in five patients (6.9%). Eighteen patients had in hospital mortality (25.0%). Tracheostomy and sphenoid fractures were found to be negative predictors of good functional outcome.Conclusions:DC is associated with an in hospital mortality of 25.0%. Favorable outcomes were seen in 51.4% patients. Tracheostomy and sphenoid fractures were negative predictors of good functional outcome. The results are comparable to international literature.

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Section: Discussionmentioning

confidence: 99%

Outcome of decompressive craniectomy in traumatic closed head injury

et al. 2018

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“…Compared to developed countries, where ICP monitoring is far more prevalent, our outcomes are broadly similar. 24,28,[42][43][44][45] Thus, we believe clinical and radiological evaluation of parameters is still equally valuable for decision making in sTBI.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors for Decompressive Hemicraniectomy in Severe Traumatic Brain Injury Patients with Traumatic Mass Lesions: A Prospective Experience from a Developing Country

et al. 2022

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Objective: To evaluate the prognostic factors affecting functional clinical outcomes in severe traumatic brain injury patients with traumatic mass lesions undergoing decompressive hemicraniectomy (DHC). Materials and Methods: A prospective cohort of 85 patients of severe traumatic brain injury patients with traumatic mass lesions underwent a unilateral decompressive hemicraniectomy. Functional outcomes were assessed using the Glasgow Outcome Score at 28 days, 3 months, and 6 months. Bivariate analysis (chi-squared) was used to identify parameters that resulted in poor outcomes and multiple regression was used to identify independent factors predicting poor outcomes. Results: 85 patients were recruited. Functional outcomes were dichotomised as favourable (Glasgow Outcome Score of 4 – 5) and poor (Glasgow Outcome Score 1-3) and evaluated at 28 days, 3 and 6 months. A total of 59 patients expired (69.4%). Bivariate analysis revealed GCS 3 – 5 at presentation (P = 0.002), midline shift greater than 7.5mm (P < 0.001), the volume of the mass lesion more than 40ml (P = 0.006) resulted in a poor outcome. Age dichotomised to less than or more than 50 years bordered statistical significance (P = 0.063). Only GCS at presentation and midline shift were independent factors that predicted poor outcomes when controlling for covariates. Conclusion: Decompressive hemicraniectomy can be a lifesaving intervention in managing severe traumatic brain injury patients with traumatic mass lesions. However, its use needs to be employed judiciously.

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“…Decompressive hemicraniectomy (DHC) is a well-established procedure for treatment of patients with elevated intracranial pressure. Underlying pathologies and indications for DHC are diverse; hence, cranioplasty procedures represent a frequently required neurosurgical procedure in a heterogeneous group of patients [1][2][3]. The procedure itself is often regarded as straightforward and technically unchallenging and is commonly performed by junior residents.…”

Section: Introductionmentioning

confidence: 99%

Cranioplasty following ventriculoperitoneal shunting: lessons learned

et al. 2020

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Objective Cranioplasty (CP) is considered as a straightforward and technically unchallenging operation; however, complication rates are high reaching up to 56%. Presence of a ventriculoperitoneal shunt (VPS) and timing of CP are reported risk factors for complications. Pressure gradients and scarring at the site of the cranial defect seem to be critical in this context. The authors present their experiences and lessons learned. Methods A consecutive series of all patients who underwent CP at the authors’ institution between 2002 and 2017 were included in this retrospective analysis. Complications were defined as all events that required reoperation. Logistic regression analysis and chi-squared test were conducted to evaluate the complication rates according to suspected risk factors. Results A total of 302 patients underwent cranioplasty between 2002 and 2017. The overall complication rate was 17.5%. Complications included epi-/subdural fluid collection (7.3%) including hemorrhage (4.6%) and hygroma (2.6%), bone graft resorption (5.3%), bone graft infection (2.0%), and hydrocephalus (5.7%). Overall, 57 patients (18.9%) had undergone shunt implantation prior to CP. The incidence of epi-/subdural fluid collection was 19.3% in patients with VPS and 4.5% in patients without VPS, OR 5.1 (95% CI 2.1–12.4). Incidence of hygroma was higher in patients who underwent early CP. Patients with temporary shunt ligation for CP did not suffer from complications. Conclusion CP in patients with a VPS remains a high-risk procedure. Any effort to understand the pressure dynamics and to reduce factors that may trigger the formation of a large epidural space must be undertaken.

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Decompressive Craniectomy in Neurocritical Care

Cited by 7 publications

References 145 publications

Outcome of decompressive craniectomy in traumatic closed head injury

Outcome of decompressive craniectomy in traumatic closed head injury

Prognostic Factors for Decompressive Hemicraniectomy in Severe Traumatic Brain Injury Patients with Traumatic Mass Lesions: A Prospective Experience from a Developing Country

Cranioplasty following ventriculoperitoneal shunting: lessons learned

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