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

Göksu, Erkan; Uçar, Tanju; Akyuz, Mahmut; Yılmaz, Murat; Kazan, Saim

doi:10.5505/tjtes.2012.79059

Cited by 11 publications

(5 citation statements)

References 40 publications

(62 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A total of 49.28% of our patients died (39.76% [DC group] vs 87.80% [CC group]). The mortality of patients with BFDPs who had undergone decompressive craniectomy was between 70% and 90%, 8 , 20 – 24 and we found that only a few studies have shown mortality between 30% and 65%, which accords with our results. Table 2 shows the relationship between mortality and different treatments.…”

Section: Discussionsupporting

confidence: 91%

See 1 more Smart Citation

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

Mao¹,

Miao²,

Hao³

et al. 2015

TCRM

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 91%

“… 7 Though the importance of DC in the treatment of patients with FDPs due to cerebral herniation has been demonstrated in some studies, there are no details of the results to confirm or refute the effectiveness of DC in those studies. 8 …”

Section: Introductionmentioning

confidence: 99%

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

Mao¹,

Miao²,

Hao³

et al. 2015

TCRM

View full text Add to dashboard Cite

show abstract

“…Evidence suggests that early DC may play an optimal care of patients with elevated ICP. [20][21][22] Article published online: 2022-09-09…”

Section: Introductionmentioning

confidence: 99%

The role of decompressive craniectomy in traumatic brain injury: A systematic review and meta-analysis

et al. 2019

View full text Add to dashboard Cite

The objective is to evaluate the efficacy of early decompressive craniectomy (DC) versus standard medical management ± late DC in improving clinical outcome in patients with traumatic brain injury (TBI). Electronic databases and gray literature (unpublished articles) were searched under different MeSH terms from 1990 to present. Randomized control trials, case–control studies, and prospective cohort studies on DC in moderate and severe TBI. Clinical outcome measures included Glasgow Coma Outcome Scale (GCOS) and extended GCOS, and mortality. Data were extracted to Review Manager software. A total of 45 articles and abstracts that met the inclusion criteria were retrieved and analyzed. Ultimately, seven studies were included in our meta-analysis, which revealed that patients who had early DC had no statistically significant likelihood of having a favorable outcome at 6 months than those who had a standard medical care alone or with late DC (OR of favorable clinical outcome at 6 months: 1.00; 95% confidence interval (CI): 0.75–1.34; P = 0.99). The relative risk (RR) of mortality in early DC versus the standard medical care ± late DC at discharge or 6 months is 0.62; 95% CI: 0.40–0.94; P = 0.03. Subgroup analysis based on RR of mortality shows that the rate of mortality is reduced significantly in the early DC group as compared to the late DC. RR of Mortality is 0.43; 95% CI: 0.26–0.71; P = 0.0009. However, good clinical outcome is the same. Early DC saves lives in patients with TBI. However, further clinical trials are required to prove if early DC improve clinical outcome and to define the best early time frame in performing early DC in TBI population.

show abstract

“…Göksu et al evaluated 28 patients with ABPR after TBI. 14 These patients underwent decompressive craniectomy. Postoperatively 9/28 (32.1%) patients had recovered their pupillary reaction bilaterally.…”

Section: Discussionmentioning

confidence: 99%

“…Of 742 patients who qualified for the study, 84 (11.3%) patients had ABPR and 88.7% patients had PBPR. There were significant differences between the two groups regarding the ISS (29 [25.75-34.25] vs. 26 [22-30], p < 0.001), GCS score (3 [3-4] vs. 13 [7][8][9][10][11][12][13][14][15], p < 0.001), and MLS (76.2 vs. 49.7%, p < 0.001). The distribution of patients with AIS 3 for the neck, chest, and abdomen in the two groups were 3.6 versus 0.5% (p ¼ 0.02), 27.4 versus 14% (p ¼ 0.002), and 4.8 versus 1.4% (p ¼ 0.049), respectively.…”

Section: Patients' Characteristics and Univariate Analysismentioning

confidence: 99%

Surgical Outcomes of Epidural Hematoma in Trauma Patients with Absent Pupillary Reactions: A National Trauma Data Analysis

Ahmed,

Kuo,

Shin

2024

J Neurol Surg A Cent Eur Neurosurg

View full text Add to dashboard Cite

Background Absent pupillary reaction occasionally heralds a poor prognosis following severe head injury. The purpose of the study was to evaluate the outcome of all patients who underwent acute evacuation of epidural hematoma (EDH) despite absent bilateral pupillary reaction. Methods The Trauma Quality Improvement Program (TQIP) database for the calendar years 2017 and 2018 was accessed for the study. Adult patients ≥18 years of age who sustained severe traumatic brain injury (TBI) with the diagnosis of EDH and underwent evacuation of the hematoma were included in the study. The patients' characteristics, injury severity score (ISS), Glasgow Coma Scale (GCS) score, midline shift, and comorbidities were compared between patients who had absence of both pupillary reaction (ABPR) and those who presented with presence of both pupillary reaction (PBPR). The primary outcome of the study was in-hospital mortality. Propensity score matching analyses were performed for the study. Results No significant differences were found between the ABPR and PBPR groups regarding the median age (37 years [interquartile range (IQR): 26–53] vs. 40 years [IQR: 28–55]), gender (males; 81.9 vs. 79.5%), median ISS (29 [25.5–34] vs. 27 [25–33]), GCS score (3 [3–4] vs. 3 [3–3], presence of significant midline shift (75.9 vs. 79.5%), and comorbidities. The patients who presented with ABPR had a significantly higher mortality (34.9 vs. 10.8%; p = 0.002). A higher number of patients were discharged to skilled nursing and rehabilitation facilities (16.7 vs. 10.8% and 46.3 vs. 41.9%, respectively; p = 0.045). Conclusion Approximately 65% of severe TBI patients survived after the evacuation of the EDH despite the absence of pupillary reaction.

show abstract

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

Cited by 11 publications

References 40 publications

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

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

The role of decompressive craniectomy in traumatic brain injury: A systematic review and meta-analysis

Surgical Outcomes of Epidural Hematoma in Trauma Patients with Absent Pupillary Reactions: A National Trauma Data Analysis

Contact Info

Product

Resources

About