Do long-term results justify decompressive craniectomy after severe traumatic brain injury?
| Autor: | Matthias H, Morgalla, Bernd E, Will, Florian, Roser, Marcos, Tatagiba |
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| Rok vydání: | 2008 |
| Předmět: |
Adult
Male Trauma Severity Indices Adolescent Ultrasonography Doppler Transcranial Brain Edema Middle Aged Decompression Surgical Postoperative Complications Treatment Outcome Brain Injuries Cerebrovascular Circulation Humans Female Intracranial Hypertension Tomography X-Ray Computed Craniotomy Follow-Up Studies |
| Zdroj: | Journal of neurosurgery. 109(4) |
| ISSN: | 0022-3085 |
| Popis: | A decompressive craniectomy can be a life-saving procedure to relieve critically increased intracranial pressure. The survival of a patient is important as well as the subsequent and long-term quality of life. In this paper the authors' goal was to investigate whether long-term clinical results justify the use of a decompressive craniectomy.Thirty-three patients (20 males and 13 females) with a mean age of 36.3 years (range 13-60 years) with severe traumatic brain injury (Grades III and IV) and subsequent massive brain swelling were examined. For postoperative assessment the Barthel Index was used. A surgical intervention was based on the following criteria: 1) The intracranial pressure could not be controlled by conservative treatment and constantly exceeded 30 mm Hg (cerebral perfusion pressure50 mm Hg). 2) Transcranial Doppler ultrasonography revealed only a systolic flow pattern or systolic peaks. 3) There were no other major injuries. 4) The patient was not older than 60 years.One-fifth of all patients died and one-fifth remained in a vegetative state. Mild deficits were seen in 6 of 33 patients. A full rehabilitation (Barthel Index 90-100) was achieved in 13 patients (39.4%). Five patients could resume their former occupation, and another 4 had to change jobs.Age remains to be one of the most important exclusion factors. Decompressive craniectomy provided good clinical results in nearly 40% of patients who were otherwise most likely to die. Therefore, long-term results justify the use of decompressive craniectomy in this case series. |
| Databáze: | OpenAIRE |
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