title: Decompressive craniectomy with multi-dural stabs - A combined (SKIMS) technique to evacuate acute subdural hematoma with underlying severe traumatic brain edema.
abstract: BACKGROUND
  The decompressive craniotomy alone or with dural flap opening to evacuate acute subdural hematoma with underlying brain edema in severe traumatic brain injury has proved either insufficient in the first place or has fatal complications secondly.
  
  
  OBJECTIVE
  To reduce the fatality of conventional procedures and to evacuate acute subdural hematoma with severe brain edema by a combination of decompressive craniotomy and multi-dural stabs (SKIMS-Technique) without brain pouting and lacerations in low Glasgow coma scale (GCS) score patients.
  
  
  METHODS
  The prospective study was conducted in the Department of Neurosurgery, from June, 2006 to June 2011, under a uniform protocol.
  
  
  METHODS
  A total of 225 patients of severe brain trauma were admitted to the accident and emergency unit of Neurosurgery and after initial resuscitation a CT brain was performed. All patients had a GCS score of 8 and below. All patients were ventilated postoperatively and ICP was monitored.
  
  
  METHODS
  The data was analyzed and evaluated by the statistical methods like student's T-test. The analysis of Variance was used where-ever applicable.
  
  
  RESULTS
  The survival of multi-dural stab group was 77.31% (92/119) with good recovery in 42.02% (50/119) and a mortality of 22.69% (27/119) as compared with 46.23% (49/106) survival in open dural flap (control) group with 15.09% (16/106) good recovery and mortality of 53.77% (57/106).
  
  
  CONCLUSIONS
  This new approach, known as SKIMS-Technique or Combined Technique i.e., "decompressive craniectomy with multi-dural stabs", proved much effective in increasing survival of low GCS and severe traumatic brain edema patients with acute subdural hematoma.
authors.affiliation: Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Kashmir, India.
authors.forename: Abdul Rashid
authors.initials: AR
authors.lastname: Bhat
authors.forename: Altaf Rehman
authors.initials: AR
authors.lastname: Kirmani
authors.forename: Mohammed Afzal
authors.initials: MA
authors.lastname: Wani
keywords: Acute subdural hematoma; SKIMS-technique; decompressive craniectomy; multi-dural stabs; outcome; severe brain edema