Outcome following decompressive craniectomy for malignant swelling due to severe head injury

Aarabi, Bizhan; Hesdorffer, Dale C.; Ahn, Edward S.; Aresco, Carla; Scalea, Thomas M.; Eisenberg, Howard M.

doi:10.3171/jns.2006.104.4.469

Cited by 531 publications

(390 citation statements)

References 116 publications

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“…27,28 There were some case series that reported outcomes after brain herniation (Table 3). [29][30][31][32][33][34][35] Unfortunately, none of these specifically commented on whether the outcomes in survivors were due to spinal cord injury. These series show that there is a high mortality after brain herniation, and that 25-50% of survivors are left with severe sequelae, including 'spastic limbs.'…”

Section: Resultsmentioning

confidence: 99%

“…These series show that there is a high mortality after brain herniation, and that 25-50% of survivors are left with severe sequelae, including 'spastic limbs.' [29][30][31][32][33][34][35] In one series of traumatic transtentorial herniation, cardiac arrest, flaccidity or bilateral fixed pupils after the herniation predicted worse neurological outcome. 33 We found only two case series of BD that specifically commented on the pathological findings in the spinal cord (Table 4).…”

Section: Resultsmentioning

confidence: 99%

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Brain death and the cervical spinal cord: a confounding factor for the clinical examination

2009

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Study design: This study is a systematic review. Objectives: Brain death (BD) is a clinical diagnosis, made by documenting absent brainstem functions, including unresponsive coma and apnea. Cervical spinal cord dysfunction would confound clinical diagnosis of BD. Our objective was to determine whether cervical spinal cord dysfunction is common in BD. Methods: A case of BD showing cervical cord compression on magnetic resonance imaging prompted a literature review from 1965 to 2008 for any reports of cervical spinal cord injury associated with brain herniation or BD. Results: A total of 12 cases of brain herniation in meningitis occurred shortly after a lumbar puncture with acute respiratory arrest and quadriplegia. In total, nine cases of acute brain herniation from various non-meningitis causes resulted in acute quadriplegia. The cases suggest that direct compression of the cervical spinal cord, or the anterior spinal arteries during cerebellar tonsillar herniation cause ischemic injury to the cord. No case series of brain herniation specifically mentioned spinal cord injury, but many survivors had severe disability including spastic limbs. Only two pathological series of BD examined the spinal cord; 56-100% of cases had upper cervical spinal cord damage, suggesting infarction from direct compression of the cord or its arterial blood supply. Conclusions: Upper cervical spinal cord injury may be common after brain herniation. Cervical spinal cord injury must either be ruled out before clinical testing for BD, or an ancillary test to document lack of brainstem blood flow is required in all cases of suspected BD. BD may not be a purely clinical diagnosis.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Brain death and the cervical spinal cord: a confounding factor for the clinical examination

2009

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“…Los estudios en adultos son series de casos o estudios de cohortes con controles históricos, y encuentran que efectivamente reduce la PIC en la mayoría de los casos (85%). Estudios de oxigenación y flujo también observan que mejoran tras la craniectomía 37 .…”

Section: Craniectomía Descompresivaunclassified

Actualizaciones en el manejo del traumatismo craneoencefálico grave

2009

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El traumatismo craneoencefálico (TCE) es una importante causa de morbimortalidad en cualquier lugar del mundo; afecta más a varones jóvenes y genera un problema de salud pública. Desafortunadamente, los avances en los conocimientos fisiopatológicos no han ido seguidos de similar desarrollo en las opciones terapéuticas, y no se dispone en la actualidad de fármacos neuroprotectores contrastados.En este artículo revisamos la epidemiología, la fisiopatología y las medidas terapéuticas utilizadas en el manejo del paciente con TCE grave. Se analizan tanto las medidas generales como las dirigidas al control de la hipertensión intracraneal, el papel de la cirugía y algunas opciones terapéu-ticas más innovadoras actualmente en fase de valoración en estos pacientes. UPDATES OF SEVERE TRAUMATIC BRAIN INJURY MANAGEMENT Traumatic brain injury (TBI)is an important reason of morbidity-mortality all over the world, affecting young males more and generating Public Health problem. Unfortunately, the advances in the pathophysiology knowledge have not followed a similar development in therapeutic options, there currently not being any contrasted neuroprotectants.In this article, we have reviewed the epidemiology, pathophysiology and therapeutic measures used in the management of patient with severe TBI. The general measures as well as those aimed at controlling intracranial hypertension, the role of the surgery and some more innovative therapeutic options currently under evaluation in these patients are analyzed.

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“…In a decompressive craniectomy, the space created allows the edematous brain to expand through the bony defect, away from the midline structures [7]. ICP values decrease by 15% once the bone fl ap is removed and by 70% once the dura is opened [8].…”

Section: Our Techniquementioning

confidence: 99%

Decompressive craniectomy: an effective but underutilized option for intracranial pressure management

Mathai

Sahoo²

2008

Indian J Surg

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Introduction Decompressive Craniectomy is an effective option in the management of intractable intracranial hypertension. Aim and objectives Neuronal conservation can be achieved by aggressive decompression (hemicraniectomy).Material and methods In this series 12 patients with a Glasgow Coma Scale score of 8 or <8 with increased intracranial pressure underwent decompressive hemicraniectomy.Results The outcomes were prospectively evaluated. Eight patients were victims of traumatic brain injury. There were two patients who had suffered malignant Middle Cerebral Artery Infarctions, one patient had a cerebral venous thrombosis and one, an intracerebral hematoma. Four patients in this cohort died, while fi ve had good outcomes. ConclusionThe rationale and role of this relatively easy but underutilised procedure are discussed.

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Outcome following decompressive craniectomy for malignant swelling due to severe head injury

Abstract: Decompressive craniectomy was associated with a better-than-expected functional outcome in patients with medically uncontrollable ICP and/or brain herniation, compared with outcomes in other control cohorts reported on in the literature.

Cited by 531 publications

References 116 publications

Brain death and the cervical spinal cord: a confounding factor for the clinical examination

Brain death and the cervical spinal cord: a confounding factor for the clinical examination

Actualizaciones en el manejo del traumatismo craneoencefálico grave

Decompressive craniectomy: an effective but underutilized option for intracranial pressure management

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