Abstract
New findings (NF) on postoperative CTs are occasionally found in patients who undergo surgery for traumatic brain injury (TBI). We conducted a retrospective registry-based review of the care of 102 patients who underwent decompressive craniectomy (DC) for TBI to investigate the prognostic factors of new findings on CT early after surgery. Of the 102 patients, the mean age was 50 years and 69.6 % were male. The overall survival was 72.5 %. The primary indication for DC included subdural hematoma in 72 (70.6 %), epidural hematoma in 17 (16.7 %), and intraparenchymal contusion in 13 (12.7 %). New findings on postoperative CTs were observed in 26 patients (25.5 %). The univariate analysis showed that a GCS score ≤8 (P = 0.012) and the absence of a basal cistern (P = 0.012) were significantly associated with NF on postoperative CT. The logistic regression analysis demonstrated that the GCS score ≤8 (P = 0.041; OR, 3.0; 95 % CI, 1.048–8.517) was the only significant factor. TBI patients with a low GCS score who underwent DC should undergo additional CT evaluations immediately after surgery.
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References
Aarabi B, Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, Eisenberg HM (2006) Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg 104:469–479
Alahmadi H, Vachhrajani S, Cusimano MD (2010) The natural history of brain contusion: an analysis of radiological and clinical progression. J Neurosurg 112:1139–1145
Cohen JE, Rajz G, Itshayek E, Umansky F (2004) Bilateral acute epidural hematoma after evacuation of acute subdural hematoma: brain shift and the dynamics of extraaxial collections. Neurol Res 26:763–766
Feuerman T, Wackym PA, Gade GF, Lanman T, Becker D (1988) Intraoperative development of contralateral epidural hematoma during evacuation of traumatic extraaxial hematoma. Neurosurgery 23:480–484
Flint AC, Manley GT, Gean AD, Hemphill JC 3rd, Rosenthal G (2008) Post-operative expansion of hemorrhagic contusions after unilateral decompressive hemicraniectomy in severe traumatic brain injury. J Neurotrauma 25:503–512
Kannus P, Palvanen M, Niemi S (2001) Time trends in severe head injuries among elderly Finns. JAMA 286:673–674
Laalo JP, Kurki TJ, Sonninen PH, Tenovuo OS (2009) Reliability of diagnosis of traumatic brain injury by computed tomography in the acute phase. J Neurotrauma 26:2169–2178
Matsuno A, Katayama H, Wada H, Morikawa K, Tanaka K, Tanaka H, Murakami M, Fuke N, Nagashima T (2003) Significance of consecutive bilateral surgeries for patients with acute subdural hematoma who develop contralateral acute epi- or subdural hematoma. Surg Neurol 60:23–30
Narayan RK, Maas AI, Servadei F, Skolnick BE, Tillinger MN, Marshall LF, Traumatic Intracerebral Hemorrhage Study Group (2008) Progression of traumatic intracerebral hemorrhage: a prospective observational study. J Neurotrauma 25:629–639
Oertel M, Kelly DF, McArthur D, Boscardin WJ, Glenn TC, Lee JH, Gravori T, Obukhov D, McBride DQ, Martin NA (2002) Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury. J Neurosurg 96:109–116
Paci GM, Sise MJ, Sise CB, Sack DI, Swanson SM, Holbrook TL, Hunstock AM, Altenau LL, Carver TW (2008) The need for immediate computed tomography scan after emergency craniotomy for head injury. J Trauma 64:326–333
Servadei F, Nanni A, Nasi MT, Zappi D, Vergoni G, Giuliani G, Arista A (1995) Evolving brain lesions in the first 12 hours after head injury: analysis of 37 comatose patients. Neurosurgery 37:899–906
Stein SC, Georgoff P, Meghan S, Mizra K, Sonnad SS (2010) 150 Years of treating severe traumatic brain injury: a systematic review of progress in mortality. J Neurotrauma 27:1343–1353
Yang XF, Wen L, Shen F, Li G, Lou R, Liu WG, Zhan RY (2008) Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases. Acta Neurochir (Wien) 150:1241–1247
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Takeuchi, S. et al. (2013). Computed Tomography After Decompressive Craniectomy for Head Injury. In: Katayama, Y., Maeda, T., Kuroiwa, T. (eds) Brain Edema XV. Acta Neurochirurgica Supplement, vol 118. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1434-6_44
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DOI: https://doi.org/10.1007/978-3-7091-1434-6_44
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