Decompressive craniectomy or not: intraoperative expe-rience in 41 patients with severe traumatic brain injury

• Main Authors: YANG Chao-hua, LI Qiang, WU Cong, MA Jun-peng, YOU Chao
• Format: Article
• Language: English
• Published: Elsevier 2012-06-01
• Series: Chinese Journal of Traumatology
• Online Access: http://www.cjtrauma.com/apps/ojs/index.php/cjt/article/view/243

【Abstract】Objective: To present our experience in using decompressive craniectomy (DC) among severe trau-matic brain injury (TBI) patients during operation and to discuss its indication. Methods: From October 2008 to May 2009, 41 patients aged between 18 and 75 years with severe TBI were in-cluded in this study. They underwent DC or non-DC (NDC) according to their intraoperative findings. Postoperative intracranial pressure (ICP), complications, requiring second operation or not and outcomes were observed. Results: Fifteen patients underwent DC and 26 pa-tients did not. The average postoperative ICP of each pa-tient was lower than 20 mm Hg. For patients received DC, 2 had seizures after operation and 1 developed cerebrocele in the follow-up period; only 1 NDC patient had post-trau-matic seizures, but none of them had delayed haematoma, cerebrospinal fluid fistula, cerebrocele or infections. At the end of follow-up, 10 patients died, 6 had the GOS of 2, 2 of 3, 9 of 4 and 14 of 5. Conclusions: DC is necessary to manage fulminant intracranial hypertension or intraoperative brain swelling. If there was not brain swelling after removal of the haematoma and necrotized neural tissues, it is safe to replace skull flap. The intraoperative finding is an important factor to decide whether to perform DC or not. Key words: Decompressive craniectomy; Brain injury; Intracranial pressure