title: Evaluation of prognostic factors of decompressive craniectomy in the treatment of severe traumatic brain injury.
abstract: OBJECTIVE
  to determine predictive factors for prognosis of decompressive craniectomy in patients with severe traumatic brain injury (TBI), describing epidemiological findings and the major complications of this procedure.
  
  
  METHODS
  we conducted a retrospective study based on analysis of clinical and neurological outcome, using the extended Glasgow outcome in 56 consecutive patients diagnosed with severe TBI scale treated in the emergency department from February 2004 to July 2012. The variables assessed were age, mechanism of injury, presence of pupillary changes, Glasgow coma scale (GCS) score on admission, CT scan findings (volume, type and association of intracranial lesions, deviation from the midline structures and classification in the scale of Marshall and Rotterdam).
  
  
  RESULTS
  we observed that 96.4% of patients underwent unilateral decompressive craniectomy (DC) with expansion duraplasty, and the remainder to bilateral DC, 53.6% of cases being on the right 42.9% on the left, and 3.6% bilaterally, with predominance of the fourth decade of life and males (83.9%). Complications were described as transcalvarial herniation (17.9%), increased volume of brain contusions (16.1%) higroma (16.1%), hydrocephalus (10.7%), swelling of the contralateral lesions (5.3%) and CSF leak (3.6%).
  
  
  CONCLUSIONS
  among the factors studied, only the presence of mydriasis with absence of pupillary reflex, scoring 4 and 5 in the Glasgow Coma Scale, association of intracranial lesions and diversion of midline structures (DML) exceeding 15 mm correlated statistically as predictors of poor prognosis.
authors.affiliation: Department of Neurosurgery, Faculty of Medical Sciences, Irmandade da Santa Casa de Misericórdia de São Paulo.
authors.forename: Nelson
authors.initials: N
authors.lastname: Saade
authors.affiliation: Department of Neurosurgery, Faculty of Medical Sciences, Irmandade da Santa Casa de Misericórdia de São Paulo.
authors.forename: José Carlos Esteves
authors.initials: JC
authors.lastname: Veiga
authors.affiliation: Department of Neurosurgery, Faculty of Medical Sciences, Irmandade da Santa Casa de Misericórdia de São Paulo.
authors.forename: Luiz Fernando
authors.initials: LF
authors.lastname: Cannoni
authors.affiliation: Department of Neurosurgery, Faculty of Medical Sciences, Irmandade da Santa Casa de Misericórdia de São Paulo.
authors.forename: Luciano
authors.initials: L
authors.lastname: Haddad
authors.affiliation: Department of Neurosurgery, Faculty of Medical Sciences, Irmandade da Santa Casa de Misericórdia de São Paulo.
authors.forename: João Luiz Vitorino
authors.initials: JL
authors.lastname: Araújo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult