Cost-effectiveness of decompressive craniectomy in traumatic brain injuries

Malmivaara, Kirsi; Kivisaari, Riku; Hernesniemi, Juha; Siironen, Jari

doi:10.1111/j.1468-1331.2010.03294.x

Cited by 28 publications

(25 citation statements)

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“…Across all indications, 10.2 % (236/2297) of patients who underwent DC developed a new ipsilateral hematoma [11, 13–20, 22, 23, 33–43]. The frequency of new ipsilateral hematoma was highest in patients who underwent DC after TBI [11, 14, 15, 17–23, 36, 38, 39, 42], at 12.9 % (188/1455). In patients who underwent DC for non-traumatic ICH, 6.5 % (7/80) developed new ipsilateral hematoma [16, 19, 34], compared to 2.5 % (2/79) who underwent DC for non-traumatic SAH [19].…”

Section: Resultsmentioning

confidence: 99%

“…Numerous studies reported meningitis or ventriculitis attributable to DC, most often in the setting of TBI [11, 14, 21, 39, 42, 77, 81–86]. The frequency of meningitis or ventriculitis was 6.1 % (63/1035) in adult patients [3, 11, 12, 14, 21, 39, 42, 56, 62, 70, 80, 81, 83–89] and 8.1 % (3/37) in pediatric patients [77, 82].…”

Section: Resultsmentioning

confidence: 99%

“…The frequency of meningitis or ventriculitis was 6.1 % (63/1035) in adult patients [3, 11, 12, 14, 21, 39, 42, 56, 62, 70, 80, 81, 83–89] and 8.1 % (3/37) in pediatric patients [77, 82]. …”

Section: Resultsmentioning

confidence: 99%

“…Defined thus, hydrocephalus was reported frequently as a complication of DC, in 16.4 % (470/2868) of adult patients. Hydrocephalus was reported in 14.8 % (290/1966) of TBI patients [10, 11, 14, 24, 25, 27, 38, 39, 42, 50–53, 73, 83, 85, 94–104]. Interestingly, hydrocephalus was reported most frequently in ischemic stroke patients [30, 31, 56, 58, 59, 80, 87, 105] and hemorrhagic stroke patients [10, 88, 106, 107], at 25.5 % (93/364) and 21.1 % (46/218), respectively.…”

Section: Resultsmentioning

confidence: 99%

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Complications Associated with Decompressive Craniectomy: A Systematic Review

et al. 2015

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Decompressive craniectomy (DC) has been used for many years in the management of patients with elevated intracranial pressure and cerebral edema. Ongoing clinical trials are investigating the clinical and cost effectiveness of DC in trauma and stroke. While DC has demonstrable efficacy in saving life, it is accompanied by a myriad of non-trivial complications that have been inadequately highlighted in prospective clinical trials. Missing from our current understanding is a comprehensive analysis of all potential complications associated with DC. Here, we review the available literature, we tabulate all reported complications, and we calculate their frequency for specific indications. Of over 1500 records initially identified, a final total of 142 eligible records were included in our comprehensive analysis. We identified numerous complications related to DC that have not been systematically reviewed. Complications were of three major types: (1) Hemorrhagic (2) Infectious/Inflammatory, and (3) Disturbances of the CSF compartment. Complications associated with cranioplasty fell under similar major types, with additional complications relating to the boneflap. Overall, one of every ten patients undergoing DC may suffer a complication necessitating additional medical and/or neurosurgical intervention. While DC has received increased attention as a potential therapeutic option in a variety of situations, like any surgical procedure, DC is not without risk. Neurologists and neurosurgeons must be aware of all the potential complications of DC in order to properly advise their patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Complications Associated with Decompressive Craniectomy: A Systematic Review

et al. 2015

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“…Depending on the patient's condition, the hematoma or damaged brain tissue will be removed. The decision of whether to keep or remove the bone flap is collectively affected by the surgical process and prognosis in order to achieve optimal overall patient outcome (17). Decompressive craniectomy is the surgical procedure of removing the bone flap, which has been shown to reduce secondary brain edema and intracranial pressure (7,10,13).…”

Section: Discussionmentioning

confidence: 99%

Factors influencing the decision to retain or remove the bone flap of adult patients with traumatic brain injury: a retrospective study

Zhang¹,

Tang²,

Liu³

et al. 2013

Turkish Neurosurgery

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AIm:To investigate clinical factors that may influence the decision to preserve or remove the bone flap during the craniectomy surgery for patients of traumatic brain injury. mATERIAL and mETHods: Clinical data from 2256 TBI patients were quantitatively analyzed and scored based on multiple clinical factors, including preoperative Glasgow Coma Scale (GCS) score, changes in pupil size, hematoma volume, time interval between injury and surgery, midline shift on CT scan, hematoma location and type, cortical collapse and the lateral ventricular shift deformation. REsuLTs:We identified several independent factors in the decision to preserve the bone flap: GCS score and pupil changes before the operation, cortical collapse, injury/surgery time interval and hematoma location. The results suggested that for patients with a combined score of ≥55, their bone flap was generally retained. For cases with a score of 50-55, the surgical decision was based on the patient level of preconscious status, changes in pupil size and the extent of postoperative cortical collapse, and for patients with a score <50, the bone flap was generally removed. CoNCLusIoN:Our scoring scheme is to identify factors that may be helpful when determining whether to remove or retain bone flap of TBI patients.

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