Early Decompressive Craniectomy after Severe Traumatic Brain Injury

Background: The role of decompressive craniectomy in the management of severe traumatic brain injury is a subject of debate in the present era. Increased intracranial pressure (ICP) can cause brain ischemia and compromised brain oxygen after severe traumatic brain injury (TBI). Decompressive craniectomy (DC) is applied to treat post-traumatic intracranial hypertension (IC H). The purpose of this study is to prove the efficacy of early decompressive craniectomy (DC) in the treatment of elevated ICP and good clinical outcome after severe head injury. Methods: A retrospective study was conducted of 21 patients who underwent cranial decompression after severe head injury. Baseline demographics, neurological examination results, and underlying pathology were reviewed. Clinical outcome was assessed by length of intensive care unit stay, length of hospital stay, and survival at discharge. Control of intracranial hypertension was assessed by intracranial pressure (ICP) monitoring and an ICP therapeutic intensity index. Radiographic outcomes were assessed by comparing preoperative and postoperative CT scans for: 1) postoperative volume of cerebral expansion and brain edema; 2) presence of uncal herniation; 3) intracerebral hemorrhage; 4) Subdural collections, and 5) brain ischemia. The patient's age, six, trauma etiology, GCS and focal neurological deficit at admittance, and associated other injuries were reviewed as well. According to GCS results, the patients were grouped as severe TBI (GCS=3-8), moderate TBI (GCS=9-13) or mild TBI (GCS=14 and 15). Only Severe TBI group are reviewed in this study while other groups are excluded. Results: DC was performed on average 2- 12 hrs after admission. DC was found to immediately reduce ICP about 6-11 mm Hg from 20, 27mmhg to 14-16mmHg). TIL, continued to improve within the postsurgical monitoring period. The duration and severity of CIB were significantly reduced as an effect of DC. The overall mortality rate in the patients was lower than predicted at the time of admission. Conclusion: These results suggest that a DC for increased ICP can reduce the CIB of the brain after severe TBI. We suggest that DC be considered early in a patient's clinical course, particularly when the TIL and ICP are increased. Also large decompressive craniectomy (frontotemproparietal) combined with enlargement of the dura by duraplasty seems to have the most favorable results beside it decrease the risk of several secondary surgical complications. (Omar Abdelhay Eldanasory and Mahmoud Farid B.A. Early Decompressive Craniectomy after Severe Traumatic Brain Injury. Life Sci J 2014;11(9):701-706). (ISSN:1097-8135). http://www.lifesciencesite.com . 106