Quality of life after hemicraniectomy for traumatic brain injury in adults

Abstract

<jats:p>Decompressive hemicraniectomy is well accepted for the surgical treatment of intractable intracranial hypertension in cases in which medical management fails. Although it is performed as a life-saving procedure when death is imminent from intracranial hypertension, little is known about the functional outcomes for these patients on long-term follow-up. In this study, the authors performed a systematic review of the literature to examine neurological outcome after hemicraniectomy. A literature search revealed 29 studies that reported outcomes using GOS scores. The GOS scores were transformed to utility values for quality of life using a conversion method based on decision analysis modeling. Based on the literature, 1422 cases were analyzed. The average 6-month-postoperative mortality rate was 28.2%. The mean QOL value among survivors was 0.592, which corresponds roughly to a GOS score of 4. Although more studies are needed for validation of long-term neurological outcome after hemicraniectomy, the assumption that most patients remain in a vegetative state after this intervention is clearly incorrect.</jats:p>

Limited Fronto-Temporo- Parietal Craniectomy in Traumatic Brain Injury: My Experience

“…However illdefi ned indications, uncertainty of timing of the surgery, unsure role of ICP monitoring, controversy of ideal size of decompression, doubtful benefi ts in terms of functional outcom and different results from different centers, has created doubts on the real advantage of this surgery. 6,10,14,25 Cochrane data base analysis in 2007 concluded that there was no evidence to support the routine use of DC to reduce unfavorable outcome in adults suffering from severe TBI with refractory intracranial hypertension.30 However in pediatric trauma patients the study showed that DC seems to reduce the risk of death and unfavorable outcome. 29 To ascertain the benefi t of surgery and to establish a consistent methodology for performing decompressive craniectomies, two studies, The early DEcompressive CRAniectomy (DECRA) trial and The Randomized Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of Intra-Cranial Pressure trial (The RESCUE ICP trial) are going on.6,16 Till then we will have to depend on one's experience, available literature and belief, to decide on the indications and benefi t of the surgery.…”

The Role of Decompressive Craniectomy in the Management of Patients Suffering Severe Closed Head Injuries

“…Severe TBI is still associated with unfavorable outcome (death or severe disability) in up to 60%. Continuous efforts of the neurosurgical community focus not only on decreasing the S-TBI associated mortality, but also on improving the quality of life and the functional outcome of patients suffering S-TBIs [Danish, et al, 2009;Honeybul, et al, 2011]. It has been demonstrated by Marmarou and his colleagues [Marmarou et al, 1991] that increased intracranial pressure (ICP) is strongly associated with poor outcome in patients suffering S-TBIs, making thus intracranial hypertension the most frequent cause of death and disability.…”

“…Does the performance of DC provide better functional outcome? Several clinical studies have suggested that DC reduces ICP but the overall functional outcome remains essentially unchanged [Danish, et al, 2009;Howard, et al, 2008;Morgalla, et al, 2008]. During the last decade a systematic attempt was made to prospectively assess the role of DC in the management of patients suffering S-TBIs and/or presenting medically refractory intracranial hypertension [Ban, et al, 2010;Morgalla et al, 2008;Valadka & Robertson, 2007].Two independent, parallel, multi-centric, prospective clinical studies (the DECRA and the Rescue ICP trials) were designed and are underway for evaluating the exact role of DC in the management of patients with S-TBIs.…”

Contralateral Acute Subdural Hematoma Following Traumatic Acute Subdural Hematoma Evacuation

“…14,15,19) Decompressive craniectomy in the management of patients with ASDH have been justified by various reports, 3,8,20) but complications secondary to surgical decompression are likely to adversely affect outcome. 9,16,20) Contralateral ASDH occurring after removal of traumatic ASDH have been reported recently as a rare but potentially lethal postoperative complication which requires consecutive operations.…”