Role of Emergency Decompressive Craniectomy in Patients of Traumatic Brain Injury

  • Dr. Sajjad Ahmad Lady Reading Hospital, MTI, Peshawar
  • Dr. Mohammad Ishaq Lady Reading Hospital, MTI, Peshawar
  • Dr. Mumtaz Ali Lady Reading Hospital, MTI, Peshawar
  • Dr. Farooq Azam Lady Reading Hospital, MTI, Peshawar
  • Dr. Zahid Khan Lady Reading Hospital, MTI, Peshawar
Keywords: Decompressive craniectomy, Traumatic brain injury, Acute subdural hematoma, Contusion, Intracerebral bleed

Abstract

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).

Author Biographies

Dr. Sajjad Ahmad, Lady Reading Hospital, MTI, Peshawar

Department of Neurosurgery,

Dr. Mohammad Ishaq, Lady Reading Hospital, MTI, Peshawar

Department of Neurosurgery

Dr. Mumtaz Ali, Lady Reading Hospital, MTI, Peshawar

Department of Neurosurgery

Dr. Farooq Azam, Lady Reading Hospital, MTI, Peshawar

Department of Neurosurgery

Dr. Zahid Khan, Lady Reading Hospital, MTI, Peshawar

Department of Neurosurgery,

References

1. Hutchinson PJ, Corteen E, Czosnyka M, Mendelow AD, Menon DK, Mitchell P et al. Decompressive craniectomy in traumatic brain injury: the randomized multicenter RESCUE ICP study. Acta Neurochir. Feb. 2006; 96: 17-20.
2. Bukhari MA, Rehman WA, Abid H. Decompressive craniectomy versus conservative management in severe traumatic brain injuries. Pak. J. of Neurol. Surg. JulSep, 2015; 19 (3): 178-82.
3. Grindlinger GA, Skavdahl DH, Ecker RD, Sanborn MR. Decompressive craniectomy for severe traumatic brain injury: Clinical study, literature review and metaanalysis. Springerplus. 2016; 5: 1-12.
4. Grille P, Tommasino N. Decompressive craniectomy in severe traumatic brain injury: prognostic factors and complications. Rev Bras Ter Intensiva. 2015; 27 (2): 113-8.
5. Wang R, Li M, Gao WW, Gao Y, Che J, Tian HL. Outcomes of early decompressive craniectomy versus conventional medical management after severe traumatic brain injury. Medicine. Oct, 2015: 94 (43): 1-9.
6. Gouello G, Hamel O, Asehnounce K, Bord E, Robert R, Buffenoir k. study of the long-term results of decompressive craniectomy after severe traumatic brain injury based on a series of 60 consecutive cases. The scientific world Journal, 2014; 2: 1-10.
7. Stirer SI. Complications of decompressive craniectomy for traumatic brain injury. Neurosurg Focus, Jun. 2009; 26 (6): 1-16.
8. Ma J, You C, Ma L, Huang S. Is decompressive craniectomy useless in severe traumatic brain injury. Critical care.2011; 1: 1-2.
9. Miranda HA, Leones SMC, Salazar LRM. Decompressive craniectomy and traumatic brain injury. A Review. Bull Emerg Trauma. 2013; 1 (2): 60-8.
10. Khan FF, Nawaz M, Khan T. Primary decompressive craniectomy-Salvation in closed TBI. Pak. J. of Neurol. Surg. Apr – Jun., 2015; 19 (2): 121-8.
11. Khalili H, Niakan A, Ghaffarpasand F, Kiani A, Behjat R. Outcome Determinants of Decompressive Craniectomy in Patients with Traumatic Brain Injury; A Single Center Experience from Southern Iran. Bull Emerg Trauma. 2017; 5 (3): 190-6.
12. Saade N, Veiga JCE, Tcbc-Sp,Cannoni LF, Haddad L, Araujo JLV. Evaluation of prognostic factors of decompressive craniectomy in the treatment of severe traumatic brain injury. Rev. Col. Bras. Cir. 2014; 41 (4): 256-62.
13. Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J et al. Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension. N Engl J Med. 2016; 375: 1119-30.
14. Ban SP, Son YJ, Yang HJ, Chung YS, Lee SH., Han DH. Analysis of Complications Following Decompressive Craniectomy for Traumatic Brain Injury. J Korean Neurosurg Soc. 48. 2010; 3: 244-50.
Published
2017-12-03
Section
Original Article