Study of the long-term results of decompressive craniectomy after severe traumatic brain injury based on a series of 60 consecutive cases.
BACKGROUND
Decompressive craniectomy can be proposed in the management of severe traumatic brain injury. Current studies report mixed results, preventing any clear conclusions on the place of decompressive craniectomy in traumatology.


METHODS
The objective of this retrospective study was to evaluate the results of all decompressive craniectomies performed between 2005 and 2011 for refractory intracranial hypertension after severe traumatic brain injury. Sixty patients were included. Clinical parameters (Glasgow scale, pupillary examination) and radiological findings (Marshall CT scale) were analysed. Complications, clinical outcome, and early and long-term Glasgow Outcome Scale (GOS) were evaluated after surgery. Finally, the predictive value of preoperative parameters to guide the clinician's decision to perform craniectomy was studied.


RESULTS
Craniectomy was unilateral in 58 cases and the mean bone flap area was 100 cm(2). Surgical complications were observed in 6.7% of cases. Mean followup was 30 months and a favourable outcome was obtained in 50% of cases. The initial Glasgow Scale was the only statistically significant predictive factor for long-term outcome.


CONCLUSIONS
Despite the discordant results in the literature, this study demonstrates that decompressive craniectomy is useful for the management of refractory intracranial hypertension after severe traumatic brain injury.
Service de Neurotraumatologie et Neurochirurgie, CHU de Nantes, 44093 Nantes, France.
Gaétane
G
Gouello
Service de Neurotraumatologie et Neurochirurgie, CHU de Nantes, 44093 Nantes, France.
Olivier
O
Hamel
Service d'Anesthésie Réanimation Chirurgicale, CHU de Nantes, 44093 Nantes, France.
Karim
K
Asehnoune
Service de Neurotraumatologie et Neurochirurgie, CHU de Nantes, 44093 Nantes, France.
Eric
E
Bord
Service de Neurotraumatologie et Neurochirurgie, CHU de Nantes, 44093 Nantes, France.
Roger
R
Robert
Service de Neurotraumatologie et Neurochirurgie, CHU de Nantes, 44093 Nantes, France ; INSERM EA3826, "Pain, Neuromodulation, and Quality of Life", CHU de Nantes, 44093 Nantes, France.
Kevin
K
Buffenoir
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult