Outcomes of Ultra-Early Decompressive Craniectomy after Severe Traumatic Brain Injury-Treatment Outcomes after Severe TBI

Abstract

ObjectiveThe beneficial effect of decompressive craniectomy in the treatment of severe traumatic brain injury (TBI) is controversial, but there is no debate that decompression should be performed before irreversible neurological deficit occurs. The aim of our study was to assess the value of ultra-early decompressive craniectomy in patients with severe TBI.MethodsTotal of 127 patients who underwent decompressive craniectomy from January 2007 to December 2013 was included in this study. Among them, 60 patients had underwent ultra-early (within 4 hours from injury) emergent operation for relief of increased intracranial pressure. Initial Glasgow coma scale, brain computed tomography (CT) scan features by Marshall CT classification, and time interval between injury and craniectomy were evaluated retrospectively. Clinical outcome was evaluated, using the modified Rankin score.ResultsThe outcomes of ultra-early decompressive craniectomy group were not better than those in the comparison group (p=0.809). The overall mortality rate was 68.5% (87 patients). Six of all patients (4.7%) showed good outcomes, and 34 patients (26.8%) remained in a severely disabled or vegetative state. Forty of sixty patients (66.7%) had died, and two patients (3.3%) showed good outcomes at last follow-up.ConclusionUltra-early decompressive craniectomy for intracranial hypertension did not improve patient outcome when compared with "early or late" decompressive craniectomy for managing severe TBI.

Clinical Outcome of Acute Epidural Hematoma in Korea: Preliminary Report of 285 Cases Registered in the Korean Trauma Data Bank System

“…Whereas the surgery 24 hours after trauma somewhat suggests a slow nature in the development of hematoma enlargement, henceforth, this is clinically associated with good outcome in our data analysis. Park et al14) also reported that the ultra-early decompressive craniectomy for TBI did not improve the patient outcome after all. Surgery should not be the only solution of treating EDH 21218).…”

“…There are number of clinical articles on the management of non-surgical EDH in the selected patients, such as elderly patients 21218). These data should be heavily considered in establishing more systematic and tailored protocols for treating EDH 121418)…”

The Effect of Preoperative Antiplatelet Therapy on Hemorrhagic Complications after Decompressive Craniectomy in Patients with Traumatic Brain Injury

“…Decompressive craniectomy (DC) is performed to decrease intracranial pressure (ICP) and to increase cerebral perfusion pressure in patients with intractable ICP resulting from various intracranial lesions 2414). DC can be a life-saving measure in patients with intractable ICP 4).…”

How does early decompressive craniectomy influence the intracranial volume relationship in traumatic brain injury (TBI) patients?

“…Severe TBI is usually associated with a poor prognosis [14,[24][25][26][27]. Outcomes of DC have been described by some authors [28,29], but the available studies were not randomised and were mostly based on small patient groups limited to individual centres. In this context, of particular interest are the results of RESCUE-ASDH -a multi-centre, pragmatic, parallel group randomised trial conducted by A. G. Kolias from the University of Cambridge's Department of Clinical Neurosciences.…”