Role of Emergency Decompressive Craniectomy in Patients of Traumatic Brain Injury
Objective: To study the role of emergency decompressive craniectomy in patients of traumatic brain injury.
Methodology: This observational study was performed in the department of Neurosurgery, MTI, LRH, Peshawar, from 1st February, 2016 to 31st January, 2017. A total of 28 patients of traumatic brain injury, who underwent emergency decompressive craniectomy within 24 hours of their admission were included in the study after applying the inclusion and exclusion criteria. A questionnaire was used to document the data. Data analysis was performed with the help of SPSS version 20.
Results: The total no. of patients were 28, out of which 21 (75%) were male and 7 (25%) were female. The mean age of all the patients was 31 ± 19.84, with a range of 10 – 80 years. The preoperative diagnosis was acute subdural hematoma (ASDH) in 15 (53.6%), large contusion in 6 (21.4%), post-traumatic intracerebral bleed in 3 (10.7%), and ASDH plus small multiple contusions in 4 (14.3%) patients. Dura was left open in all the cases. The preoperative mean GCS was 8.39 ± 3.01. A total of 8 (28.6%) patients expired during the first postoperative week. The mean GCS of the remaining 20 patients at discharge was 10.55 ± 4.05. At 3 months follow-up, 7 (25%) patients were in vegetative state (GOS2), 3 (10.7%) were having major disability (GOS3) and 10 (35.7%) had good (GOS 4 and 5) clinical outcome.
Conclusion: The decompressive craniectomy can be very helpful in patients of traumatic brain injury because it can lower the ICP and improve the survival rate in TBI patients.
Abbreviations: GCS (Glasgow Coma Scale), GOS (Glasgow Outcome Scale), ICP (Intracranial Pressure).
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