Decompressive craniectomy for severe traumatic brain injury: Evaluation of the effects at one year*

Abstract

In 40 patients with intractable intracranial hypertension and at very high risk of brain death, decompressive craniectomy allowed 25% of patients to attain social rehabilitation at 1 yr.

Decompressive Craniectomy for Intractable Intracranial Hypertension

“…Decompressive craniectomy has been shown to reduce this mortality to 20-35% [2,14,15]. Few recent studies on malignant ischemic stroke demonstrate that early surgery even before the pupil dilates may increase the number of patients with a favourable functional outcome [6,16,17]. In our study, although the mean time between the onset of ischemic stroke and the operation was aproximately 60 hours, these CVA patients still had mild disability with full survival.…”

Effective ICP Reduction by Decompressive Craniectomy in Patients with Severe Traumatic Brain Injury Treated by an ICP-Targeted Therapy

“…Our study is one of the few studies where craniectomy was performed within a strict protocol. Previously reported ranges of favorable outcome (GOS 5-4) have been 26-66%, with a mortality of 14.7-52% (Gaab et al, 1990;Polin et al, 1997;Kunze et al, 1998;Guerra et al, 1999;Meier et al, 2000;Munch et al, 2000;Whitfield et al, 2001;Kontopoulos et al, 2002;Schneider et al, 2002;Albanese et al, 2003;Meier and Grawe, 2003). Thus, our results in severe TBI were at least as good as the best results in the above-mentioned studies.…”

“…To reduce ICP during intracranial hypertension, decompressive craniectomy (DC) has been used (Kocher, 1901;Cushing, 1905). During the past decades, several different experiences with DC in TBI have been reported (Gaab et al, 1990;Polin et al, 1997;Guerra et al, 1999;Meier et al, 2000;Munch et al, 2000;Whitfield et al, 2001;Hejazi et al, 2002;Schneider et al, 2002;Albanese et al, 2003;Meier and Grawe, 2003).…”

Monitoring and treatment of severe traumatic brain injury

“…[68]. Многие авторы рекомендуют более раннее выполнение ДК, сразу после госпитализации, до установки ВЧД монитора [69]. Имеют значение и размеры краниотомии (рис.…”