Decompressive craniectomy as the primary surgical intervention for hemorrhagic contusion.
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.
Huang
Abel Po-Hao
AP
Department of Neurosurgery, Department of Surgery, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taipei, Taiwan.
Tu
Yong-Kwang
YK
Tsai
Yi-Hsin
YH
Chen
Yuan-Shen
YS
Hong
Wei-Chen
WC
Yang
Chi-Cheng
CC
Kuo
Lu-Ting
LT
Su
I-Chang
IC
Huang
She-Hao
SH
Huang
Sheng-Jean
SJ
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