Long-time outcome after transient transtentorial herniation in patients with traumatic brain injury.
BACKGROUND
This study investigates mortality and morbidity in patients with traumatic brain injury (TBI) who developed episode(s) of transtentorial herniation. The transtentorial herniation was defined as a deterioration of consciousness accompanied by uni- or bilateral pupil dilatation.


METHODS
The medical records of all patients with traumatic brain injury admitted during 1999 to the Neuro- or General Intensive Care Units at Sahlgrenska University Hospital were analyzed, and patients with at least one episode of transtentoryal herniation were included. Information regarding patient age, gender, type of trauma, initial GCS, precipitating reason for herniation, uni-/bilateral pupil dilatation, treatment(s) and outcome after at least 6 months, assessed with the Glasgow Outcome Scale (GOS), was collected from medical records.


RESULTS
The study included 27 patients, average age 44 years (range 6-81), with a male proportion of 81%. The majority of the patients were victims of traffic accidents and falls. The results demonstrated that 16/27(59%) of the patients had a favorable outcome (GOS 4/5), 4/27(15%) were severely disabled (GOS 3), none was vegetative (GOS 2) and 7/27(26%) died (GOS 1). When analyzing patient subgroups, best outcome was found in children where 3/4 (75%) had a GOS 4/5.


CONCLUSIONS
Transtentorial herniation is a serious consequence of supratentorial edema/mass lesions in patients with TBI. However, with aggressive neurointensive care and neurosurgical treatments we found a 59% patient incidence of a favorable outcome.
Skoglund
T S
TS
Department of Neurosurgery, Sahlgrenska University Hospital, S-413 Göteborg, Sweden. thomas.skoglund@vgregion.se
Nellgård
B
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications*; D002526:Cerebellar Diseases / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D002648:Child; D004234:Diuretics, Osmotic / Q000627:therapeutic use; D004677:Encephalocele / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006801:Humans; D006985:Hyperventilation; D008297:Male; D008353:Mannitol / Q000627:therapeutic use; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D015996:Survival Rate; D013995:Time; D016896:Treatment Outcome
D004234:Diuretics, Osmotic; D008353:Mannitol