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Decompressive craniectomies, facts and fiction: a retrospective analysis of 526 cases

  • Clinical Article
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Abstract

Background

The aim of this article was to review the clinical practice of “bone flap decompression” in Regional Neurosurgical Units with no particular protocol in use.

Methods

From January 2005 to December 2008, a retrospective and multicentre study was conducted on patients who were treated with decompressive craniectomy (DC) in seven departments of neurosurgery in Italy. This study included patients with traumatic brain injury, stroke, aneurysmal subarachnoid haemorrhage and cerebral arteriovenous malformations. Data were retrieved from individual medical records.

Results

We identified 526 patients with DC. Age was the most significant predictor factor of survival, together with pupil reactivity, time of decompression and size of the bone flap. The effect of age in predicting survival was so important that in patients over 65 years old we did not find any other significant factor related to survival. In younger patients, the survival rate was much better with a large bone flap (p = 0.01). Unfortunately, 57% of patients were decompressed with a bone flap of less than 12 cm in diameter. This was probably due to the association in 80% of cases between haematoma evacuation and decompression.

Conclusions

The current practice in many centres is different from published papers. Decompression is common over the age of 65 years, is associated with haematoma evacuation and often the bone flaps are inadequate in terms of size.

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Acknowledgments

The authors wish to thank the following doctors who contributed to patient care and inclusion in the study:

Azienda Ospedaliero Universitaria Parma: Drs. Marsilio Saccavini, Rodolfo Brianti, Mario Mergoni and Eugenio Benericetti; and Prof. Guido Fanelli. Azienda Santa Maria Nuova Reggio Emilia: Drs. Walter Bottari, Giovanni Battista Camurri and Reza Ghadirpour. Azienda Sanitaria Locale di Modena: Drs. Pietro Pinna, Marco Franceschini and Raffaele Stacca. Azienda Ospedaliero Universitaria di Ferrara: Drs. Roberto Padovani and Aurelia Guberti. Azienda Sanitaria Locale di Bologna: Drs. Giovanni Gordini, Marco Zanello and Alvaro Andreoli; Prof. Fabio Calbucci and Dr. Roberto Piperno. Azienda Sanitaria Locale di Cesena: Drs. Luigi Targa, Arturo Chieregato, Roberto Battaglia, Gilberto Vergoni and Andrea Naldi. Dr. Christian Compagnone is thanked for his kind help with statistical data evaluation.

Conflicts of interest

None.

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Authors and Affiliations

  1. Second Department of Anesthesiology, Intensive Care and Pain Therapy, Azienda Ospedaliero Universitaria di Parma, Via A. Gramsci 14, Parma, Italy

    Fernanda Tagliaferri

  2. Rehabilitation Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy

    Giulia Zani & Nino Basaglia

  3. Neurtraumatology-Neurosurgery Unit, Azienda Ospedaliero-Universitaria di Parma and Azienda Santa Maria Nuova, Parma and Reggio Emilia, Italy

    Corrado Iaccarino & Franco Servadei

  4. Emilia Romagna Regional Health Care Department, Bologna, Italy

    Salvatore Ferro & Lorenza Ridolfi

  5. Department of Neurosurgery, University of Cambridge, Cambridge, UK

    Peter Hutchinson

Authors
  1. Fernanda Tagliaferri
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  2. Giulia Zani
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  3. Corrado Iaccarino
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  4. Salvatore Ferro
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  5. Lorenza Ridolfi
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  6. Nino Basaglia
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  7. Peter Hutchinson
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  8. Franco Servadei
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Correspondence to Fernanda Tagliaferri.

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Tagliaferri, F., Zani, G., Iaccarino, C. et al. Decompressive craniectomies, facts and fiction: a retrospective analysis of 526 cases. Acta Neurochir 154, 919–926 (2012). https://doi.org/10.1007/s00701-012-1318-0

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  • DOI: https://doi.org/10.1007/s00701-012-1318-0

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