| Popis: |
Decompressive craniotomy is frequently used after removal of compressive traumatic intracranial haematomas as surgical treatment of postoperative brain edema and raised intracranial pressure. In recent articles (Gaab 1990, Stula 1992) opinions about the value of this kind of treatment differ. We analysed 53 patients suffering severe head injuries (CGS 3-8) with surgically treated posttraumatic compressive intracranial haemorrhage. Patients were divided in two groups. Group I included patients with osteoplastic craniotomy (N=25), and group II those with decompressive craniotomy (N=28). Patients with subarachnoid and intraventricular haemorrhage, politraumatized and patients with complicated (open) head injuries were excluded. General and specific parameters were compared in both groups. The comparison of general parameters (e.g. age, sex, injury mechanisms, type of intracranial haematoma) showed no statistical difference between the two groups (Mann-Whitney U test). The comparison of specific parameters (ICP, CPP, MAP) showed no statistical difference between the two groups (Mann-Whitney U test). Mortality rate was 36% in group I, and 46% in group II. There were no significant statistical difference in mortality rate comparing both groups (Mann-Whitney U test and x2 test). Higher mortality rate observed in group II was most probably result of already intraoperative existed malignant brain edema which did not allow replacement of bone graft. Such patients had GCS 3-5 at time of admission. Observing mortality rate after surgery, we noticed no benefit in patients with decompressive craniotomy while comparing general and specific parameters of both groups. There is no benefit from decompressive craniotomy applied as additional surgical method in the treatment of expected postoperative brain edema. Decompressive craniotomy should be performed only in patients developing severe intraoperative brain edema which does not allow replacement of bone graft. |
