Decompressive Craniectomy in Patients with Uncontrollable Intracranial Hypertension

Kunze, Ekkehard; Meixensberger, Jürgen; Janka, Michael; Sörensen, N.; Roosen, K.

doi:10.1007/978-3-7091-6475-4_5

Cited by 66 publications

(70 citation statements)

References 4 publications

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“…Reduction of refractory ICP has been shown to be a major predictor of mortality following TBI, 21,25,31,42 and many studies have confirmed the positive effects of craniectomy on reducing ICP following TBI. 1,37,49,50 However, few randomized controlled studies exist that specifically address the effectiveness of craniectomy in pediatric populations to improve clinical outcome.…”

Section: Surgical Interventions For Tbi In the Pediatric Populationmentioning

confidence: 99%

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Appelboom

Zoller

Piazza

et al. 2011

FOC

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Traumatic brain injury (TBI) is the current leading cause of death in children over 1 year of age. Adequate management and care of pediatric patients is critical to ensure the best functional outcome in this population. In their controversial trial, Cooper et al. concluded that decompressive craniectomy following TBI did not improve clinical outcome of the analyzed adult population. While the study did not target pediatric populations, the results do raise important and timely clinical questions regarding the effectiveness of decompressive surgery in pediatric patients. There is still a paucity of evidence regarding the effectiveness of this therapy in a pediatric population, and there is an especially noticeable knowledge gap surrounding age-stratified interventions in pediatric trauma. The purposes of this review are to first explore the anatomical variations between pediatric and adult populations in the setting of TBI. Second, the authors assess how these differences between adult and pediatric populations could translate into differences in the impact of decompressive surgery following TBI.

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Section: Surgical Interventions For Tbi In the Pediatric Populationmentioning

confidence: 99%

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Appelboom

Zoller

Piazza

et al. 2011

FOC

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“…Mortality and morbidity rates for STBI patients remain high despite improvements in emergency care, imaging, critical care, medical and surgical treatment options, and rehabilitation It may be possible to achieve better outcomes with modulations and developments in treatment principles. In general, STBI patients are initially treated with first tier standard medical treatment, and second tier options such as high dose barbiturate therapy, mild hypothermia, mild hyperventilation and DC are used if this proves ineffective in reducing intracranial pressure (ICP) (10,18,20,21,25,26).…”

Section: Introductionmentioning

confidence: 99%

Effect of early bilateral decompressive craniectomy on outcome for severe traumatic brain injury

Akyuz

Uçar²,

Açikbas³

et al. 2009

Turkish Neurosurgery

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AIM:Debate continues as to whether decompressive craniectomy (DC) is an effective treatment for severe traumatic brain injury (STBI). DC is mostly used as a second tier treatment option. The aim of this study was determined whether early bilateral DC is effective as a first tier treatment option in patients with STBI. MATERIAL and METHODS:The study compared two groups. Group 1 comprised 36 STBI patients for whom control of intracranial pressure (ICP) was not achieved with conservative treatment methods according to radiological and neurological findings. These patients underwent bilateral or unilateral DC as a second tier treatment. Group 2 comprised 40 STBI patients who underwent early bilateral DC as a first tier treatment. RESULTS: Group 2 patients had a mean better outcome than Group 1patients, especially for patients with a GCS 6-8. Postoperative ICP was lower in Group 2 patients than Group 1 patients. CONCLUSION: This study indicates that early bilateral DC can be effective for controlling ICP in STBI patients. It is likely the favorable outcome results for Group 2 patients reflects the relatively short time between trauma and surgery. Therefore, these data indicate early bilateral DC can be considered as a first tier treatment in STBI patients.

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“…1,2,4-7,9,11, [14][15][16]18,19,21,22,25,[27][28][29][31][32][33][34][35][36][37][38][39][40] The mean years of patient accrual were between 1987 and 2005. Total numbers in each GOS category are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…This heterogeneity limits the precision of our estimates. We cannot adjust for a number of clinical factors known to be associated with outcome, such as age, 1,11,15,21,27,28 timing of surgery, 15,24,27 admission GCS score, preoperative pupillary examination, and other features. 12,21 We chose QOL as an outcome measure over GOS scores because of its almost universal use in quantitative studies of medical outcomes 10 and because of its conformance to mathematical calculations, such as determining mean values and confidence intervals.…”

Section: 26mentioning

confidence: 99%

Quality of life after hemicraniectomy for traumatic brain injury in adults

Danish

Barone

Lega

et al. 2009

FOC

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Decompressive hemicraniectomy is well accepted for the surgical treatment of intractable intracranial hypertension in cases in which medical management fails. Although it is performed as a life-saving procedure when death is imminent from intracranial hypertension, little is known about the functional outcomes for these patients on long-term follow-up. In this study, the authors performed a systematic review of the literature to examine neurological outcome after hemicraniectomy. A literature search revealed 29 studies that reported outcomes using GOS scores. The GOS scores were transformed to utility values for quality of life using a conversion method based on decision analysis modeling. Based on the literature, 1422 cases were analyzed. The average 6-month-postoperative mortality rate was 28.2%. The mean QOL value among survivors was 0.592, which corresponds roughly to a GOS score of 4. Although more studies are needed for validation of long-term neurological outcome after hemicraniectomy, the assumption that most patients remain in a vegetative state after this intervention is clearly incorrect.

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Decompressive Craniectomy in Patients with Uncontrollable Intracranial Hypertension

Cited by 66 publications

References 4 publications

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Effect of early bilateral decompressive craniectomy on outcome for severe traumatic brain injury

Quality of life after hemicraniectomy for traumatic brain injury in adults

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