The bigger, the better? About the size of decompressive hemicraniectomies

Tanrikulu, Levent; Oez-Tanrikulu, A.; Weiss, Claus; Scholz, Torben; Schiefer, Johannes; Clusmann, Hans; Schubert, Gerrit Alexander

doi:10.1016/j.clineuro.2015.04.019

Cited by 40 publications

(24 citation statements)

References 16 publications

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“…In cases requiring DC, the center in which larger bone flaps were performed (82.4 vs 52.4 cm 3 ) produced better clinical outcomes (67% good results [GOS Score 4 or 5] vs 46%). Tanrikulu et al 18 compared different sizes of DC (12)(13)(14)(15)(15)(16)(17)(18)(19)(20), and 20-24 cm) and found no additional benefit in wider craniectomies provided that the lower limit of 12 cm is observed.…”

Section: Review Of the Surgical Technique For DCmentioning

confidence: 99%

Randomized controlled study comparing 2 surgical techniques for decompressive craniectomy: with watertight duraplasty and without watertight duraplasty

Vieira¹,

Guimarães²,

Faquini³

et al. 2018

Journal of Neurosurgery

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Rapid-closure DC without watertight duraplasty is a safe procedure. It is not associated with a higher incidence of surgical complications (CSF leak, wound infection, brain abscess, or subgaleal fluid collections), and it decreased surgical time by 31 minutes on average. There was also a hospital cost reduction of $420.00 USD (23.4% reduction) per procedure. Clinical trial registration no.: NCT02594137 (clinicaltrials.gov).

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Section: Review Of the Surgical Technique For DCmentioning

confidence: 99%

Randomized controlled study comparing 2 surgical techniques for decompressive craniectomy: with watertight duraplasty and without watertight duraplasty

Vieira¹,

Guimarães²,

Faquini³

et al. 2018

Journal of Neurosurgery

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“…The decision for decompressive surgery in malignant MCA infarction is made on the basis of radiological data and progressing clinical course. The American Heart Association/American Stroke Association (AHA/ASA) updated the guidelines recommending DC in malignant MCA infarction in patients 60 years old or less with unilateral MCA infarctions that are neurologically deteriorating within 48 h despite maximal medical treatments [7].…”

Section: Introductionmentioning

confidence: 99%

Decompressive craniectomy in malignant hemispheric infarction: favorable outcome and disability

Elsayed

2019

Egypt J Neurol Psychiatry Neurosurg

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Context: Patients with malignant middle cerebral artery (MCA) infarction are prone to a mortality rate of 70-80%. Decompressive craniectomy (DC) has been used as an important treatment modality to control refractory intracranial hypertension. Aim: In this study, we aimed to evaluate the impact of DC in reducing mortality rate and improving the functional outcome in the patients who underwent DC surgery for malignant MCA infarction Settings and design: The prospective clinical case study included 24 patients with refractory intracranial hypertension due to malignant MCA infarction Patients and methods: All patients enrolled in the study have refractory intracranial hypertension due to malignant MCA infarction; they were allocated to undergo decompressive craniectomy between 2014 and 2017. Each patient was evaluated clinically using the Glasgow Coma Scale (GCS) and the modified Rankin Scale (mRS). Results: All patients on admission have the GCS of 5-12 score (mean 8). Fourteen patients underwent DC in the first 48 h while 10 patients were operated upon after 48 h. Postoperatively, two patients (9%) had a score of 3 on the modified Rankin Scale, six patients (25%) had a score of 4, and eight patients (33%) had a score of 5. Mortality occurred in eight patients (33%) with the worst score of 6. Similar unfavorable outcome was reported at 6-and 12-month follow-up with different degrees of disability. Conclusion: Decompressive craniectomy for malignant MCA infarction has an effective role in decreasing the mean intracranial pressure, reducing the mortality rate, and increasing the number of patients with a favorable outcome.

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“…Early decompression included a >12 cm by 12 cm hemispheric craniectomy[ 7 ] either with or without dural closure. Surgical criteria for the procedure included: Obliteration of the basal cisterns, midline shift of >0.5 cm, acute subdural hematoma wider than 1cm, epidural hematomas of >30 cc in volume, or intracerebral hemorrhage of >50 cc in volume [ Figure 1 ].…”

Section: Methodsmentioning

confidence: 99%

Results of early cranial decompression as an initial approach for damage control therapy in severe traumatic brain injury in a hospital with limited resources

Charry

Rubiano

Nikas

et al. 2016

Journal of Neurosciences in Rural Practice

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Introduction:Severe traumatic brain injury (sTBI) is a disease that generates significant mortality and disability in Latin America, and specifically in Colombia. The purpose of this study was to evaluate the 12-month clinical outcome in patients with sTBI managed with an early cranial decompression (ECD) as the main procedure for damage control (DC) therapy, performed in a University Hospital in Colombia over a 4-year period.Materials and Methods:A database of 106 patients who received the ECD procedure, and were managed according to the strategy for DC in neurotrauma, was analyzed. Variables were evaluated, and the patient outcome was determined according to the Glasgow Outcome Score (GOS) at 12 months postinjury. This was used to generate a dichotomous variable with “favorable” (GOS of 4 or 5) or “unfavorable” (GOS of 1–3) outcomes; analysis of variance was performed with the Chi-square, Wilcoxon–Mann–Whitney and Fisher tests.Results:An overall survival rate of 74.6% was observed for the procedure, At 12 months postsurgery, a favorable clinical outcome (GOS 4–5) was found in 70 patients (66.1%), Unfavorable outcomes in patients were associated with the following factors: Closed trauma, an Injury Severity Score >16, obliterated basal cisterns, subdural hematoma as the main injury seen on the admission computed tomography, and nonreactive pupils observed in the emergency department.Conclusion:Twelve months outcome of patients with sTBI managed with ECD in a neuromonitoring limited resource University Hospital in Colombia shows an important survival rate with favorable clinical outcome measure with GOS.

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The bigger, the better? About the size of decompressive hemicraniectomies

Cited by 40 publications

References 16 publications

Randomized controlled study comparing 2 surgical techniques for decompressive craniectomy: with watertight duraplasty and without watertight duraplasty

Randomized controlled study comparing 2 surgical techniques for decompressive craniectomy: with watertight duraplasty and without watertight duraplasty

Decompressive craniectomy in malignant hemispheric infarction: favorable outcome and disability

Results of early cranial decompression as an initial approach for damage control therapy in severe traumatic brain injury in a hospital with limited resources

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