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

Abstract

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.

Effects of decompressive surgery in patients with severe traumatic brain injury and bilateral non-reactive dilated pupils

“…In our previous study, we compared 40 STBI patients who underwent early bilateral DC as a first-tier treatment with 36 patients in whom surgical treatment was considered as a second step. [25] In the early bilateral DC group, especially in patients <40 years and with an initial GCS score of ≥6, the favorable outcome rate was significantly higher. However, treatment is not clear in patients who suddenly develop bilateral pupillary dilation in the early posttraumatic period.…”

Defining meaningful outcomes after decompressive craniectomy for traumatic brain injury: Existing challenges and future targets

“…For example, seven studies reported that data was collected by neurosurgeons, trauma surgeons, physicians, nursing staff and research staff [7,[32][33][34][35][36][37] and the remaining studies did not report who conducted the assessments. Six studies reported conducting telephone interviews [7, 32, 34-37] and three studies also conducted face-to-face interviews [7,32,33]. One group retrospectively determined the condition of the patients using the GOS from the clinical records [38].…”

“…The most widely used global outcome measure following DC is the the Glasgow Outcome Score (GOS [6,27,32,36,50,[56][57][58]). Although the GOS is widely used by neurosurgeons to assess functional outcomes following TBI, it has received criticism due to its susceptibility to systematic bias among different professional groups [39], poor interrater reliability [40], ambiguity within the upper classification categories due to multidimensional criteria and lack of sensitivity to change during the course of rehabilitation [59].…”

Decompressive craniectomy in traumatic brain injury: Quo Vadis?

“…In addition to these promising clinical results, new data suggested that complications of TBI may be reduced following early decompression [14][15][16][17].…”