title: Decompressive craniectomy as the primary surgical intervention for hemorrhagic contusion.
abstract: The standard surgical treatment of hemorrhagic cerebral contusion is craniotomy with evacuation of the focal lesion. We assessed the safety and feasibility of performing decompressive craniectomy and duraplasty as the primary surgical intervention in this group of patients. Fifty-four consecutive patients with Glasgow Coma Scale (GCS) scores of less than or equal to 8, a frontal or temporal hemorrhagic contusion greater than 20 cm(3) in volume, and a midline shift of at least 5 mm or cisternal compression on computer tomography (CT) scan were studied. Sixteen (29.7%) underwent traditional craniotomy with hematoma evacuation, and 38 (70.4%) underwent craniectomy as the primary surgical treatment. Mortality, reoperation rate, Glasgow Outcome Scale-Extended (GOSE) scores, and length of stay in both the acute care and rehabilitation phase were compared between these two groups. Mortality (13.2% vs. 25.0%) and reoperation rate (7.9% vs. 37.5%) were lower in the craniectomy group, whereas the length of stay in both the acute care setting and the rehabilitation phase were similar between these two groups. The craniectomy group also had better GOSE score (5.55 vs. 3.56) at 6 months. Decompressive craniectomy is safe and effective as the primary surgical intervention for treatment of hemorrhagic contusion. This study also suggests that patient with hemorrhagic contusion can possibly have better outcome after craniectomy than other subgroup of patients with severe traumatic brain injury.
authors.affiliation: Department of Neurosurgery, Department of Surgery, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Abel Po-Hao
authors.initials: AP
authors.lastname: Huang
authors.forename: Yong-Kwang
authors.initials: YK
authors.lastname: Tu
authors.forename: Yi-Hsin
authors.initials: YH
authors.lastname: Tsai
authors.forename: Yuan-Shen
authors.initials: YS
authors.lastname: Chen
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Hong
authors.forename: Chi-Cheng
authors.initials: CC
authors.lastname: Yang
authors.forename: Lu-Ting
authors.initials: LT
authors.lastname: Kuo
authors.forename: I-Chang
authors.initials: IC
authors.lastname: Su
authors.forename: She-Hao
authors.initials: SH
authors.lastname: Huang
authors.forename: Sheng-Jean
authors.initials: SJ
authors.lastname: Huang
mesh_terms: D000328:Adult; D020201:Brain Hemorrhage, Traumatic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology; D003399:Craniotomy; D003646:Debridement; D019299:Decompression, Surgical; D004322:Drainage; D004388:Dura Mater / Q000601:surgery; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012086:Reoperation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome