Optimal Bone Flap Size for Decompressive Craniectomy for Refractory Increased Intracranial Pressure in Traumatic Brain Injury: Taking the Patient's Head Size into Account

Schur, Solon; Martel, Philippe; Marcoux, Judith

doi:10.1016/j.wneu.2020.01.232

Cited by 27 publications

(21 citation statements)

References 15 publications

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“…Regarding TBI and ischemic stroke, the relationship between DC size and clinical outcome has been reported in several studies [11][12][13][14][15][16]. The majority of prospective trials recommended 12 cm as the minimum diameter of DC [28,29].…”

Section: Parameter Aor (95% Ci) Pmentioning

confidence: 99%

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Size does matter: The role of decompressive craniectomy extent for outcome after aneurysmal subarachnoid hemorrhage

Jabbarli

Oppong

et al. 2021

Euro J of Neurology

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Background and purpose In previous studies in patients with traumatic brain injury and ischemic stroke, the size of decompressive craniectomy (DC) was reported to be paramount with regard to patient outcomes. We aimed to identify the impact of DC size on treatment results in individuals with aneurysmal subarachnoid hemorrhage (SAH). Methods The extent of DC in 232 patients with SAH who underwent bifrontal or hemicraniectomy between January 2003 and December 2015 was analyzed using semi‐automated surface measurements. The study endpoints were course of intracranial pressure (ICP) treatment after DC, occurrence of cerebral infarcts, in‐hospital mortality, and unfavorable outcome at 6 months (defined as modified Rankin scale score >3). The associations of DC size with the study endpoints were adjusted for DC timing, patient age, clinical and radiographic severity of SAH, aneurysm location, and treatment modality. Results The mean DC surface area was 100.9 (±45.8) cm2. In multivariate analysis, a large DC (>105 cm2) was independently associated with a lower risk of cerebral infarcts (adjusted odds ratio [aOR] 0.30, 95% confidence interval [CI] 0.16–0.56), in‐hospital mortality (aOR 0.28, 95% CI 0.14–0.56) and unfavorable outcome (aOR 0.51, 95% CI 0.27–0.98). Moreover, SAH patients with a small DC size (<75 cm2) were more likely to require prolonged (>3 days, aOR 3.60, 95% CI 1.37–9.42) and enhanced (aOR 2.31, 95% CI 1.12–4.74) postoperative ICP treatment. Conclusion This is the first study showing the impact of DC size on postoperative ICP control and patient outcome in the context of SAH; specifically, a large craniectomy flap (>105 cm2) might lead to better outcomes in SAH patients requiring decompressive surgery.

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Section: Parameter Aor (95% Ci) Pmentioning

confidence: 99%

“…The importance of DC size for functional outcome was shown for patients with traumatic brain injury (TBI) and ischemic stroke [11][12][13][14][15][16]. In contrast, less is known about the clinical value of DC size in SAH patients undergoing decompressive surgery.…”

Section: Introductionmentioning

confidence: 99%

Size does matter: The role of decompressive craniectomy extent for outcome after aneurysmal subarachnoid hemorrhage

Jabbarli

Oppong

et al. 2021

Euro J of Neurology

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“…The current guidelines recommend a bone flap measuring at least 12 × 15 cm [3]. If the head size is taken into account, a bone flap circumference over skull hemicircumference of >65% is usually sufficient [18].…”

Section: Discussionmentioning

confidence: 99%

Resection of swollen temporal muscles in patients with intractable intracranial hypertension after decompressive craniectomy

Huang

et al. 2021

Acta Neurochir

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Background Decompressive craniectomy is employed as treatment for traumatic brain swelling in selected patients. We discussed the effect of temporal muscle resection in patients with intractable intracranial hypertension and temporal muscle swelling after craniectomy. Methods Records of 280 craniectomies performed on 258 patients who were admitted with severe head injury were retrospectively reviewed. Eight patients developed intractable increased intracranial pressure with temporal muscle swelling within 24 h after craniectomy and were treated by muscle resection. Results The initial Glasgow Coma Scale score was 7 ± 1. The mean intracranial pressure was 41.7 ± 8.59 mmHg before muscle resection and 14.81 ± 8.07 mmHg immediately after surgery. Five patients had skull fracture and epidural hematoma at the craniectomy site. The mean intensive care unit stay was 11.25 ± 5.99 days. Glasgow Outcome Scale-Extended scoring performed during the 12-month follow-up visit showed that 6 patients (75%) had a favorable outcome. Conclusions Our study findings indicate that a direct impact on the temporal region during trauma may lead to subsequent temporal muscle swelling. Under certain circumstances, muscle resection can effectively control intracranial pressure.

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“…Traumatic brain injury, as a common disease in neurosurgery, refers to the organic damage to the brain tissue caused by severe head trauma (1,2), with a rather high disability rate and fatality rate. Clinical manifestations include symptoms such as disturbance of consciousness, dizziness, and headache, the delayed treatment for which may give rise to complications such as permanent dysfunction, amnesia, and epilepsy, jeopardizing patients' life safety and hindering the quality of life (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Etiology Analysis and Diagnosis and Treatment Strategy of Traumatic Brain Injury Complicated With Hyponatremia

Zhang

Wei²,

Dou³

et al. 2022

Front. Surg.

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ObjectiveTo explore the etiology and diagnosis and treatment strategy of traumatic brain injury complicated with hyponatremia.Methods90 patients with traumatic brain injury admitted to our hospital from December 2019 to December 2020 were retrospectively analyzed and divided into hyponatremic group (50 patients) and non-hyponatremic group (40 patients) according to the patients' concomitant hyponatremia, and the clinical data of the two groups were collected and compared. In addition, patients in the hyponatremia group were divided into a control group and an experimental group of 25 patients each according to their order of admission, with the control group receiving conventional treatment and the experimental group using continuous renal replacement therapy (CRRT). Hemodynamic indices, mortality and serum neuron-specific enolase (NSE) indices before and after treatment were compared between the control and experimental groups. The Glasgow coma scale (GCS) was used to assess the degree of coma before and after the treatment in the two groups, and the patients' disease status was assessed using the Acute Physiological and Chronic Health Evaluation Scoring System (APACHE II).ResultsThe etiology of traumatic brain injury complicated with hyponatremia is related to the degree of brain injury, ventricular hemorrhage, cerebral edema, and skull base fracture (P < 0.05). After the treatment, the hemodynamic indexes, APACHE II scores, death rate, and NSE levels of the experimental group were significantly lower than those of the control group (P < 0.001); The experimental group yielded remarkably higher GAC scores as compared to the control group (P < 0.001).ConclusionThe degree of brain injury, ventricular hemorrhage, cerebral edema, and skull base fracture were considered to be the main factors for traumatic brain injury complicated with hyponatremia. Continuous renal replacement therapy can effectively improve the clinical indicators of the patients with a promising curative effect, which merits promotion and application.

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Optimal Bone Flap Size for Decompressive Craniectomy for Refractory Increased Intracranial Pressure in Traumatic Brain Injury: Taking the Patient's Head Size into Account

Cited by 27 publications

References 15 publications

Size does matter: The role of decompressive craniectomy extent for outcome after aneurysmal subarachnoid hemorrhage

Size does matter: The role of decompressive craniectomy extent for outcome after aneurysmal subarachnoid hemorrhage

Resection of swollen temporal muscles in patients with intractable intracranial hypertension after decompressive craniectomy

Etiology Analysis and Diagnosis and Treatment Strategy of Traumatic Brain Injury Complicated With Hyponatremia

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