Do long-term results justify decompressive craniectomy after severe traumatic brain injury?
OBJECTIVE
A decompressive craniectomy can be a life-saving procedure to relieve critically increased intracranial pressure. The survival of a patient is important as well as the subsequent and long-term quality of life. In this paper the authors' goal was to investigate whether long-term clinical results justify the use of a decompressive craniectomy.


METHODS
Thirty-three patients (20 males and 13 females) with a mean age of 36.3 years (range 13-60 years) with severe traumatic brain injury (Grades III and IV) and subsequent massive brain swelling were examined. For postoperative assessment the Barthel Index was used. A surgical intervention was based on the following criteria: 1) The intracranial pressure could not be controlled by conservative treatment and constantly exceeded 30 mm Hg (cerebral perfusion pressure<50 mm Hg). 2) Transcranial Doppler ultrasonography revealed only a systolic flow pattern or systolic peaks. 3) There were no other major injuries. 4) The patient was not older than 60 years.


RESULTS
One-fifth of all patients died and one-fifth remained in a vegetative state. Mild deficits were seen in 6 of 33 patients. A full rehabilitation (Barthel Index 90-100) was achieved in 13 patients (39.4%). Five patients could resume their former occupation, and another 4 had to change jobs.


CONCLUSIONS
Age remains to be one of the most important exclusion factors. Decompressive craniectomy provided good clinical results in nearly 40% of patients who were otherwise most likely to die. Therefore, long-term results justify the use of decompressive craniectomy in this case series.
Morgalla
Matthias H
MH
Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany. matthias.morgalla@med.uni-tuebingen.de
Will
Bernd E
BE
Roser
Florian
F
Tatagiba
Marcos
M
D000293:Adolescent; D000328:Adult; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000601:surgery*; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D002560:Cerebrovascular Circulation; D003399:Craniotomy; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial