Surgical decompression for traumatic brain swelling: indications and results

Guerra, Waltraud Kleist-Welch; Gaab, M. R.; Dietz, H.; Mueller, Jan-Uwe; Piek, J.; Fritsch, Michael

doi:10.3171/jns.1999.90.2.0187

Cited by 368 publications

(116 citation statements)

References 56 publications

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“…On the other hand, decompressive craniectomy (DC) can reduce morbidity and mortality in critically ill patients with massive ischemic infarction [1,2,3,4] and severe head injury [5,6,7]. However, the role of DC in poor-grade SAH remains obscure.…”

Section: Introductionmentioning

confidence: 99%

Surgical Outcome following Decompressive Craniectomy for Poor-Grade Aneurysmal Subarachnoid Hemorrhage in Patients with Associated Massive Intracerebral or Sylvian Hematomas

Otani

Takasato²,

Masaoka³

et al. 2008

Cerebrovasc Dis

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Background: Patients with poor-grade aneurysmal subarachnoid hemorrhage (SAH) presenting with large intracerebral (ICH) or sylvian hematomas (SylH) have poor outcomes due to the mass effect of significant brain stem compression following mass effect. On the other hand, decompressive craniectomy (DC) can reduce morbidity and mortality in critically ill patients with massive ischemic infarction and severe head injury. However, the role of DC in SAH patients is not fully understood. We investigated the outcome of DC in poor-grade SAH presenting with large ICH or SylH. Methods: 110 consecutive patients with poor-grade SAH (Hunt & Kosnik (H&K) grades IV and V, and Fisher group 4) were admitted to our hospital between April 1, 1993, and July 30, 2004. We treated 57 of those who presented with large ICH or SylH using DC. We retrospectively reviewed medical charts, radiological findings, operative notes, and video records. Results: Among the 57 patients (mean age 57.8, male 29, female 28), 25 were classified as H&K grade IV and 32 as grade V. Ruptured aneurysms were located on the internal carotid artery in 11 and the middle cerebral artery in 46 patients. 50 of the aneurysms were small, 5 were medium, and 2 were large. Rerupture was preoperatively confirmed in 13 (22.8%). Hypothermia was applied to 17 (29.8%). The Glasgow Outcome Scale on discharge showed good recovery, moderate recovery, severe disability, vegetative state, and death in 8 (14.0%), 13 (22.8%), 16 (28.1%), 8 (14.0%), and 12 (21.1%), respectively. The outcomes of grade IV patients were favorable and poor in 14 (56.0%) and 10 (40.0%), respectively, and 1 (4.0%) died. Conclusion: Several experimental studies have also indicated that DC significantly improves outcome due to reduced intracranial pressure or increased perfusion pressure. Urgent DC for poor-grade SAH with space-occupying hematoma can lead to survival with good recovery in some patients.

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Section: Introductionmentioning

confidence: 99%

Surgical Outcome following Decompressive Craniectomy for Poor-Grade Aneurysmal Subarachnoid Hemorrhage in Patients with Associated Massive Intracerebral or Sylvian Hematomas

Otani

Takasato²,

Masaoka³

et al. 2008

Cerebrovasc Dis

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“…Аналогічні результати наведені W.K. Guerra та співавторами [23]: сприятливий результат досягнутий у 58% пацієнтів, смертність становила 19%. G.P.…”

Section: дåêîìïðåñèвíà êðàí³åêòîì³я ó ïîòåðï³ëèх ç òяAeêîю чåðåïíî-ìîunclassified

Decompressive craniectomy performing at severe cranio-cerebral trauma

Pedachenko¹,

Dzyak²,

Sirko³

2011

Ukr Neurosurg J

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“…However, in rare situations, malignant brain edema following severe head injuries can produce severe, sustained rise of ICP that does not respond to the usual treatment (refractory intracranial hypertension; IH), and an infant may develop brain infarction. In adults and children in similar situations, decompressive craniectomy is prescribed as a last resort treatment [3, 4, 5]. The author in this report presents a 6-month-old infant who developed refractory IH and massive brain infarction following head trauma.…”

Section: Introductionmentioning

confidence: 99%

Bifrontal Decompressive Craniotomy in a 6-Month-Old Infant with Posttraumatic Refractory Intracranial Hypertension

Elwatidy

2005

Pediatr Neurosurg

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Objective: To document the outcome of bifrontal decompressive craniotomy (BDC) in an infant who developed refractory intracranial hypertension (IH) and massive brain infarction following severe head injury. Clinical Presentation: A 6-month-old girl sustained a severe closed head injury in a car accident. Her Glasgow coma score dropped from 10 to 6/15 within 6 h after admission, and her pupils became dilated and fixed. CT brain scans showed severe brain swelling and extensive infarction in both cerebral hemispheres with no grey-white mater differentiation. She developed a state of refractory IH despite maximal medical treatment. Intervention: She hadBDC and duraplasty carried out 8 h after admission. She made a quick recovery to Glasgow outcome score 3, and her total hospital stay was 10 weeks. Conclusion: BDC can be a life-saving procedure for infants with refractory IH and massive brain infarction.

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Surgical decompression for traumatic brain swelling: indications and results

Abstract: Surgical decompression should be routinely performed when indicated before irreversible ischemic brain damage occurs.

Cited by 368 publications

References 56 publications

Surgical Outcome following Decompressive Craniectomy for Poor-Grade Aneurysmal Subarachnoid Hemorrhage in Patients with Associated Massive Intracerebral or Sylvian Hematomas

Surgical Outcome following Decompressive Craniectomy for Poor-Grade Aneurysmal Subarachnoid Hemorrhage in Patients with Associated Massive Intracerebral or Sylvian Hematomas

Decompressive craniectomy performing at severe cranio-cerebral trauma

Bifrontal Decompressive Craniotomy in a 6-Month-Old Infant with Posttraumatic Refractory Intracranial Hypertension

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