Summary
There has been controversial discussion about the benefits of decompressive craniectomy in patients with critically raised intracranial pressure (ICP) after severe head injury. The aim of this retrospective study was to analyze the results of secondary decompressive craniectomy in patients with uncontrollable raised ICP after maximum aggressive medical treatment. The data of 28 patients (mean age 22 years, range 8–44 years) with severe head injury and posttraumatic cerebral edema were analyzed retrospectively. Surgery was not indicated in patients with vast primary lesions, hypoxia, ischemic infarction, brainstem injuries and central herniation. The outcome was classified according to the Glascow Outcome Scale (GOS) after one year. The decompressive crainectomy was performed an average of 68 hours after trauma, and ICP (<25 mm Hg) decreased always while cerebral perfusion pressure (CPP < 75mm Hg) improved as well as cerebral blood flow and microcirculation to normal values. 15 patients (56%) had a good outcome after one year (GOS 4 + 5).
5 patients (18%) were severely disabled, 4 patients (14%) remained in vegetative state and 3 patients (11%) died. Decompressive craniectomy should be kept in mind as the last therapeutic step, especially in young patients with head injury and raised ICP, which is not controllable with conservative methods.
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References
Cushing H (1905) The establisment of cerebral hernia as a decompressive measure for inaccessible brain tumors. Surg Gynecol Obstet 1: 297–314
Gaab MR, Knoblich OE, Fuhrmeister U, Pflughaupt KW, Dietrich K (1979) Comparison of the effects of surgical decompression and resection of local edema in the therapy of experimental brain trauma. Childs Brain 5: 484–498
Karlen J, Stular D (1987) Dekompressive Kraniotomie bei schwerem Schädelhirntrauma nach erfolgloser Behandlung mit Barbituraten. Neurochirurgica 30: 35–39
Kjellberg RM (1971) Bifrontal decompression craniotomy for massive cerebral edema. J Neurosurg 34: 488–493
Rittierodt M, Gaab MR, Lorenz M (1991) Decompressive cranietomy. After severe head injury: Useful therapy in pathophysiologically guided indication. Adv Neurosurg 19: 265–273
Schwab S, Rieke K, Krieger D, Hund E, Aschoff A, Kummer RV, Hacke W (1995) Kraniektomie bei raumfordernden Mediainfarkten. Nervenarzt 66: 430–437
Venes JL, Collins WF (1975) Bifrontal decompressive craniectomy in the management of head trauma: J Neurosurg 42: 429–433
Whitfield P, Guazzo E (1955) ICP reduction following decompressive craniectomy. Stroke 26(6): 1125–1126
Wirtz CR, Steiner T, Aschoff A, Schwab S, Schnippering H, Steiner HH, Hacke W, Kunze S (1997) Hemicraniectomy with dural augmentation in medically uncontrollable hemispheric infarction. Neurosurgical Focus 2(5): Article 3
Yamamura A, Uemura K, Makino H (1979) Large decompressive Craniectomy in managemnt of severe cerebral contusions; a review of 207 cases. Neurol Med Chir 19: 711–728
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© 1998 Springer-Verlag Wien
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Kunze, E., Meixensberger, J., Janka, M., Sörensen, N., Roosen, K. (1998). Decompressive Craniectomy in Patients with Uncontrollable Intracranial Hypertension. In: Marmarou, A., et al. Intracranial Pressure and Neuromonitoring in Brain Injury. Acta Neurochirurgica Supplements, vol 71. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6475-4_5
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DOI: https://doi.org/10.1007/978-3-7091-6475-4_5
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