Combined internal uncusectomy and decompressive craniectomy for the treatment of severe closed head injury: experience with 80 cases
| Autor: | Salvatore, Chibbaro, Chibbaro, Salvatore, Marco, Marsella, Marsella, Marco, Antonio, Romano, Romano, Antonio, Salvatore, Ippolito, Ippolito, Salvatore, Eugenio, Benericetti, Benericetti, Eugenio |
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| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Decompression medicine.medical_treatment Glasgow Outcome Scale Neurosurgical Procedures Brain herniation Head trauma Head Injuries Closed medicine Humans Retrospective Studies Intracranial pressure business.industry Glasgow Coma Scale General Medicine Middle Aged Decompression Surgical medicine.disease Surgery Treatment Outcome Closed head injury Female Decompressive craniectomy Intracranial Hypertension business Follow-Up Studies |
| Zdroj: | Journal of Neurosurgery. 108:74-79 |
| ISSN: | 1933-0693 0022-3085 |
| DOI: | 10.3171/jns/2008/108/01/0074 |
| Popis: | Object Transtentorial brain herniation is a major cause of morbidity and death following severe closed head injury. The purpose of this study was to evaluate the efficacy of selective uncoparahippocampectomy and tentorial splitting as an adjuvant method of treating otherwise uncontrollable elevated intracranial pressure (ICP) while attempting to prevent or minimize the devastating consequences caused by transtentorial herniation. Methods The authors retrospectively reviewed data from a series of 80 consecutive cases of severe closed head injury (Glasgow Coma Scale [GCS] score Results All injuries were caused by blunt trauma with signs of acute and/or progressive increased ICP causing downward transtentorial herniation. Fifty-eight patients were male and 22 were female with a mean age of 35 years and a mean preoperative GCS score of 5. Based on the current American Association of Neurological Surgeons guidelines for head trauma, an intraparenchymal ICP device (Camino, Integra) was placed in all patients who had a GCS score 20 cm H2O. Whenever possible, risks and benefits were explained to family members, and then surgery was performed within 3–16 hours (median 6 hours). At a mean follow-up of 30 months, the outcome was favorable (Glasgow Outcome Scale [GOS] score of 4 or 5) in 60 patients (75%) and unfavorable (GOS score of 3) in 8 (10%), whereas the remaining 12 patients (15%) died at some point during the postoperative course. There was no survivor patient in a vegetative state. A younger age had a significant effect on positive outcome (p < 0.0005), as did an earlier operation (p < 0.04). The preoperative neurological status as assessed using the GCS as well as pupillary reactivity had no significant effect on outcome (p = 0.054 and p > 0.05, respectively). Conclusions A selective uncoparahippocampectomy with a tentorial edge incision and a wide decompressive craniectomy with duraplasty can be an effective adjuvant form of aggressive treatment to improve outcome in patients with severe closed head injury, especially in those who are younger if they are treated promptly. |
| Databáze: | OpenAIRE |
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