Comparison of the effect of decompressive craniectomy on different neurosurgical diseases.
BACKGROUND
Many previous studies have reported that decompressive craniectomy has improved clinical outcomes in patients with intractable increased intracranial pressure (ICP) caused by various neurosurgical diseases. However there is no report that compares the effectiveness of the procedure in the different conditions. The authors performed decompressive craniectomy following a constant surgical indication and compared the clinical outcomes in different neurosurgical diseases.


METHODS
Seventy five patients who underwent decompressive craniectomy were analysed retrospectively. There were 28 with severe traumatic brain injury (TBI), 24 cases with massive intracerebral haemorrhage (ICH), and 23 cases with major infarction (MI). The surgical indications were GCS score less than 8 and/or a midline shift more than 6 mm on CT. The clinical outcomes were assessed on the basis of mortality and Glasgow Outcome Scale (GOS) scores. The changes of ventricular pressure related to the surgical intervention were also compared between the different disease groups.


RESULTS
Clinical outcomes were evaluated 6 months after decompressive craniectomy. The mortality was 21.4% in patients with TBI, 25% in those with ICH and 60.9% in MI. A favourable outcome, i.e. GOS 4-5 (moderate disability or better) was observed in 16 (57.1%) patients with TBI, 12 (50%) with ICH and 7 (30.4%) with MI. The change of ventricular pressure after craniectomy and was 53.2 (reductions of 17.4%) and further reduced by 14.9% (with dural opening) and (24.8%) after returning to its recovery room, regardless of the diseases group.


CONCLUSIONS
According to the mortality and GOS scores, decompressive craniectomy with dural expansion was found to be more effective in patients with ICH or TBI than in the MI group. However, the ventricular pressure change during the decompressive craniectomy was similar in the different disease groups. The authors thought that decompressive craniectomy should be performed earlier for the major infarction patients.
Kim
Ki-Tae
KT
Department of Radiology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, South Korea.
Park
Jin-Kyu
JK
Kang
Seok-Gu
SG
Cho
Kyung-Suck
KS
Yoo
Do-Sung
DS
Jang
Dong-Kyu
DK
Huh
Pil-Woo
PW
Kim
Dal-Soo
DS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000150:complications* / Q000503:physiopathology; D020520:Brain Infarction / Q000150:complications / Q000503:physiopathology; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000150:complications / Q000503:physiopathology; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology; D003399:Craniotomy / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D019299:Decompression, Surgical / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011859:Radiography; D012189:Retrospective Studies; D012886:Skull / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome