Decompressive craniectomy for severe traumatic brain injury patients with fixed dilated pupils

Abstract

ObjectiveThe outcome of decompressive craniectomy (DC) for severe traumatic brain injury (sTBI) patients with fixed dilated pupils (FDPs) is not clear. The objective of this study was to validate the outcome of DC in sTBI patients with FDPs.PatientsWe retrospectively collected data from 207 sTBI patients with FDPs during the time period of May 4, 2003–October 22, 2013: DC group (n=166) and conservative care (CC) group (n=41).MeasurementsOutcomes that were used as indicators in this study were mortality and favorable outcome. The analysis was based on the Glasgow Outcome Scale recorded at 6 months after trauma.ResultsA total of 49.28% patients died (39.76% [DC group] vs 87.80% [CC group]). The mean increased intracranial pressure values after admission before operation were 36.20±7.55 mmHg in the DC group and 35.59±8.18 mmHg in the CC group. After performing DC, the mean ICP value was 14.38±2.60 mmHg. Approximately, 34.34% sTBI patients with FDPs in the DC group gained favorable scores and none of the patients in the CC group gained favorable scores.ConclusionWe found that DC plays a therapeutic role in sTBI patients with FDPs, and it is particularly important to reduce intracranial pressure as soon as possible after trauma. For the patients undergoing DC, favorable outcome and low mortality could be achieved.

The Role of Decompressive Craniectomy in Limited Resource Environments

“…Studies from China (23–26) show different results with lower mortality in patients under DC with mixed techniques (unilateral and bi-frontal) in pediatric and adult population. In general survival with GOS 4-5 was over 50%.…”

Early or late cranioplasty following decompressive craniotomy for traumatic brain injury: A systematic review and meta-analysis

“…Although the indications and efficacy of DC remain controversial, a large number of DC procedures are now performed worldwide and so many patients undergo subsequent CP. 1 , 27 – 31…”

“…Although the indications and efficacy of DC remain controversial, a large number of DC procedures are now performed worldwide and so many patients undergo subsequent CP. 1,[27][28][29][30][31] Initially, CP was considered to have a protective and cosmetic role only but recent studies have shown that it also improves neurological function. 2,6,18,32 In addition, CP may restore some abnormalities caused by the DC, such as changes in CSF circulation, dynamics of local cerebral blood flow, cerebral metabolic rate of oxygen and glucose changes.…”

Death after discharge: prognostic model of 1-year mortality in traumatic brain injury patients undergoing decompressive craniectomy

“…Our main inclusion criterion covered patients who underwent DC with a history of TBI. The main indications and approach were described in previous studies [ 14 , 15 ]. The exclusion criteria were as follows: (1) an interval from injury to admission of more than 24 h; (2) death in the hospital; (3) other severe systemic diseases, such as malignant tumors, cirrhosis, and uremia; and (4) loss to follow-up.…”