Dural-stabs after wide craniectomy to decompress acute subdural hematoma with severe traumatic brain edema — An alternative technique to open dural flap

Abstract

The Department of Neurosurgery Sher-i-Kashmir Institute of Medical Sciences (SKIMS) Srinagar, a single neurosurgical centre in Kashmir valley, assessed prospectively, under a uniform protocol, 120 patients of severe traumatic brain edema with acute subdural hematoma by wide decompressive craniectomy with dural-stabs in 60(cases) patients as against conventional dural opening (open dural flap) and removal of acute subdural hematoma in 60(controls) patients during a period of 3 years (June 2006 to June 2009). A free bone flap was elevated and preserved. All patients had GCS (Glassgow Coma Scale) score of 8 and less. The elective ventilation and ICP monitoring was carried out in all patients. Most patients were young and males with a mean age of 30 years in both groups. The overall survival of the dural-stab group (case-study) was 78.3% with good recovery in 43.3% and a mortality of 21.6% (13/60) as compared to 40% survival in open dural flap (control) group with 11.6% good recovery and a mortality of 60% (36/60). The conventional (open dural flap) procedure to remove the clot proved dangerous in a traumatic ?vent-searching? and edematous brain, restricted in a rigid cranial vault. This midway-approach, known in SKIMS as ?dural-stabs?, between the only decompressive craniectomy and removal of acute subdural clot by open dural flap (conventional) method, proved much effective in increasing survival of low GCS and severe traumatic brain edema with acute subdural hematoma. In conclusion decompressive craniectomy alone is not sufficient and open dural flap is full of risk in such patients.

Decompressive craniectomy with multi-dural stabs - A combined (SKIMS) technique to evacuate acute subdural hematoma with underlying severe traumatic brain edema

“…The dural-stabs for the evacuation of acute subdural hematoma as a procedure has been used on 60 patients by the authors. [20]…”

Comparison of the Efficacy of Multi Dural Stab Craniectomy with Open Dural Flap Craniectomy in Patients Having Acute Subdural Hematoma

“…Civilians have been the primary targets in previous wars, accounting for more than 80% of those wounded and killed. 7 The most fatal of all head injuries is traumatic acute subdural hematoma, in which the initial brain damage is more important than the clot. The capacity to regulate ICP, rather than the removal of the subdural clot, determines the result.…”

Comparison of Outcome of Decompressive Craniectomy with Wide Dural Flap Duraplasty Versus Dural Slits in the Management of Post Traumatic Acute Subdural Hematoma in Terms of Postoperative CSF Leak

“…In conclusion, a simple decompressive craniectomy alone does not provide more benefit and an open dural flap is full of risk in such patients. [0][1][2][3][4][5][6][7][8][9][10][11][12] In a recent systematic literature review Barthélemy et al has evaluated decompressive craniectomy after severe TBI, by comparing the literature with first major RCT on this topic (DECRA). They found that when a comparison was done between Decompressive Craniectomy with multiple dural stabs and DC with open dural flap, dural stab group was found to have a significant advantage in mortality and GOS.…”

“…They did not analyze the early complications like a CSF leak in different DC techniques. 7,[3][4][5][6][7][8][9][10][11][12][13][14][15][16] Subsequently, Bhat et al analyzed evacuation of acute SDH by a combination of DC and multi-dural stabs (SKIMS-Technique) without brain herniation and lacerations in low GCS score patients. Survival in multi-dural stab group was 77.31% (92/119) with 42.02% (50/119) good recovery and 22.69% (27/119) mortality as compared with survival of 46.23% (49/106) in open dural flap (control) group with good recovery in15.09% (16/106) and 53.77% (57/106).…”