Relationship between Clinical Outcomes and Superior Sagittal Sinus to Bone Flap Distance during Unilateral Decompressive Craniectomy in Patients with Traumatic Brain Injury: Experience at a Single Trauma Center

Shim, Hyuk Ki; Yu, Seung Han; Kim, Byung Chul; Lee, Jung Hwan; Lee, Jae Il

doi:10.13004/kjnt.2018.14.2.99

Cited by 8 publications

(2 citation statements)

References 30 publications

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“…[ 4 – 6 ] Whereas DC can reduce mortality, it can also increase the incidence of unfavorable outcomes; consequently, the decision to perform DC is always challenging. [ 7 , 8 ] Furthermore, there is significant uncertainty with regards to selecting the appropriate candidates for this procedure, and choosing the optimal time for surgery. [ 9 , 10 ]…”

Section: Introductionmentioning

confidence: 99%

Outcomes of patients undergoing craniotomy and decompressive craniectomy for severe traumatic brain injury with brain herniation

Lan

Richard

et al. 2020

Medicine

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The treatment of severe traumatic brain injury (TBI) with brain herniation is challenging because outcomes are often associated with high mortality and morbidity. Our aim was to identity factors contributing to decompressive craniectomy (DC) and evaluate treatment outcomes in patients with severe TBI with brain herniation. In this retrospective study, we analyzed medical records of severe TBI with brain herniation from May 2009 to December 2013. We reviewed their demographic data, mechanism of injury, Glasgow Coma Scale (GCS) score, pupil status, computed tomography findings, surgical treatment methods, time interval between brain herniation and surgery, as well as outcomes. GCS and pupil status are clinical parameters for detecting increase intracranial pressure while brain parenchyma bulged above the inner plate of the skull during operation indicated brain swelling as well as increased intracranial pressure on which basis the decision to perform DC or craniotomy was determined intraoperatively. One hundred ninety-four patients were included in the study. We performed DC in 143 of the patients while 51 of them we performed craniotomy. There were no statistically significant differences in the age, gender, or injury mechanism between the 2 groups. GCS, pupillary dilation, midline shift, hematoma type and timing of surgery were associated with DC. Nevertheless, logistic regression analysis revealed that hematoma type and timing of surgery were significantly associated with favorable DC outcomes ( P < .001 and P = .023). Subdural hematoma and timing of surgery >1 hour were both identified as risk factors for DC. Six months after TBI, 34.0% of patients exhibited favorable outcomes. Overall mortality rate was 30.4%. Age, GCS, pupil dilation, hematoma type, and timing of surgery were all associated with patient outcomes. Further logistic regression analysis revealed that, lower GCS, bilateral pupil dilation, timing of surgery >1 hour, and advanced age were independent risk factors for poor outcomes ( P = .001, P = .037, P = .028, and P = .001, respectively). Our study revealed that, DC is not mandatory for all TBI patients with brain herniation. Nevertheless, DC decreases mortality rate in severe TBI patients with brain herniation. Subdural hematoma and timing of surgery >1 hour are key indicators for DC. Lower GCS, bilateral pupil dilation, delayed timing of surgery and advance age are indicators of poor outcomes.

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Section: Introductionmentioning

confidence: 99%

Outcomes of patients undergoing craniotomy and decompressive craniectomy for severe traumatic brain injury with brain herniation

Lan

Richard

et al. 2020

Medicine

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“…Surgical removal of intracranial hematoma and fractured brain tissue (craniotomy/decompression craniectomy) can reduce the mortality of severe TBI, incidence of ICP, and length of hospital stay in TBI patients [2][3][4]. Surgery, however, could also worsen the clinical outcomes of TBI [5,6], partly due to secondary injury, increased gastrointestinal bleeding and in ammatory complications [4,[7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Administration of Yunnan Baiyao improved clinical prognosis of emergency craniotomy in patients with moderate-to-severe TBI: a randomized controlled trial

Chen¹,

Jiang²,

Xing³

et al. 2020

Preprint

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Background: Although emergency craniotomy has been performed to reduce the mortality of traumatic brain injury (TBI), it is associated with secondary injury and poor prognosis. The efficacy of a wound-healing medicine Yunnan Baiyao (YB) was compared with a TBI medicine Xingnaojing (XNJ) and orthodox therapy (OT). Method: Eighty patients (39±7 yrs.) with moderate-to-severe TBI (Glasgow Coma Scale(GOS), 3-12) received craniotomy before randomly assigned to (n=20) 7 days treatment of: 1) OT; 2) OT+XNJ (20 ml i.v. drip/daily); 3) OT+low dose-YB (oral, 1,000 mg/day); 4) OT+high dose-YB, 2,000 mg/day). Serum S100B and superoxide dismutase (SOD), Glasgow Outcome Scale (GOS) and Karnofsky Performance Scale (KPS) were evaluated.Results: GCS score was lowest on admission that improved more quickly and became significantly higher in XNJ, l-YB, h-YB groups than in OT group (P<0.01). S100B peaked higher but declined more slowly and became significantly higher in OT than in other groups (P<0.01). By Day 7, S100B declined to 20% below baseline in other groups but remained 19.4% above baseline in OT group. OT lost 38% SOD activity on Day 3 and regained 69% of SOD activity on Day 7 whereas other groups lost 16.7%~23.4% SOD on Day 3 but regained 91.8%~99.5% activity on Day 7 (P<0.01). GOS and KPS scores were significantly greater (~25%~30%) in the XNJ, l-YB, h-YB groups than in OT group 1-3 months post-surgery. Conclusion: YB is significantly better than OT and non-inferior to XNJ in improving postoperative recovery and clinical prognosis after emergency craniotomy in patients with moderate-to-severe TBI.

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Unilateral supratentorial decompressive craniectomy: stay away from the midline!

Beucler

2023

Eur J Trauma Emerg Surg

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Relationship between Clinical Outcomes and Superior Sagittal Sinus to Bone Flap Distance during Unilateral Decompressive Craniectomy in Patients with Traumatic Brain Injury: Experience at a Single Trauma Center

Cited by 8 publications

References 30 publications

Outcomes of patients undergoing craniotomy and decompressive craniectomy for severe traumatic brain injury with brain herniation

Outcomes of patients undergoing craniotomy and decompressive craniectomy for severe traumatic brain injury with brain herniation

Administration of Yunnan Baiyao improved clinical prognosis of emergency craniotomy in patients with moderate-to-severe TBI: a randomized controlled trial

Unilateral supratentorial decompressive craniectomy: stay away from the midline!

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